Cancer Screening of Long-term Cancer Survivors
Cancer Screening of Long-term Cancer Survivors
Survey participants in 1992–1993 (before cancer) were 53 years old, on average, with relatively high levels of income and education (Table 1). Eighty-nine percent reported good/excellent health. Participants who went on to receive a cancer diagnosis were significantly more likely than those who did not to be older, male, have a family history of cancer, and have a higher education level.
The most frequently diagnosed cancers were prostate, breast, and colorectal, which were commonly diagnosed at a local stage (Table 2). Fifty-six percent of cancers were diagnosed within 5 years of the 2003–2004 survey. There was moderate variation in the proportion of participants who received cancer screening (Table 3). Proportions ranged from 62% for Papanicolaou smears/pelvic exams to 76% for mammograms.
Controlling for factors before cancer and insurance factors, women with cancer were more likely than those without to receive cancer screening (Table 4). Female cancer survivors were more likely to receive Papanicolaou smears/pelvic exams (70%; 95% confidence interval [CI], 63% to 76%) and mammograms (86%; 95% CI, 78% to 90%) than were women without cancer (61%; 95% CI, 59% to 63%; and 76%; 95% CI, 74% to 77%, respectively). Once women with the cancer associated with a given screening test were excluded, the difference for pelvic examination/Papanicolaou smear remained (69%; 95% CI, 63% to 76%; and 61%; 95% CI, 59% to 63%, respectively), though the difference for mammograms was no longer statistically significant (80%; 95% CI, 69% to 86%; and 76%; 95% CI, 74% to 77%). Among men, cancer survivors were not significantly more likely than men without cancer to receive prostate exams (76%; 95% CI, 70% to 82%; and 69%; 95% CI, 67% to 71%, respectively), nor were they more likely to receive them after prostate cancer survivors were excluded (69%; 95% CI, 57% to 77%; and 69%; 95% CI, 67% to 71%, respectively).
The association between a cancer diagnosis and cancer screening differed by the amount of time a person had cancer. Within 5 years of diagnosis, cancer survivors were more likely than controls to have had cancer screening tests other than for prostate cancer. However, the only difference in cancer screening among longer-term survivors compared to no-cancer controls was for mammograms (86%; 95% CI, 78% to 92%; and 76%; 95% CI, 74% to 77%, respectively) (Table 4). Once participants with a history of the cancer associated with the screening test were excluded, there were few significant differences for short-term survivors and no significant differences for longer-term cancer survivors compared with no-cancer controls. The magnitude of the differences described remained when after-cancer provider and patient factors were included in the models.
Results
Survey participants in 1992–1993 (before cancer) were 53 years old, on average, with relatively high levels of income and education (Table 1). Eighty-nine percent reported good/excellent health. Participants who went on to receive a cancer diagnosis were significantly more likely than those who did not to be older, male, have a family history of cancer, and have a higher education level.
The most frequently diagnosed cancers were prostate, breast, and colorectal, which were commonly diagnosed at a local stage (Table 2). Fifty-six percent of cancers were diagnosed within 5 years of the 2003–2004 survey. There was moderate variation in the proportion of participants who received cancer screening (Table 3). Proportions ranged from 62% for Papanicolaou smears/pelvic exams to 76% for mammograms.
Controlling for factors before cancer and insurance factors, women with cancer were more likely than those without to receive cancer screening (Table 4). Female cancer survivors were more likely to receive Papanicolaou smears/pelvic exams (70%; 95% confidence interval [CI], 63% to 76%) and mammograms (86%; 95% CI, 78% to 90%) than were women without cancer (61%; 95% CI, 59% to 63%; and 76%; 95% CI, 74% to 77%, respectively). Once women with the cancer associated with a given screening test were excluded, the difference for pelvic examination/Papanicolaou smear remained (69%; 95% CI, 63% to 76%; and 61%; 95% CI, 59% to 63%, respectively), though the difference for mammograms was no longer statistically significant (80%; 95% CI, 69% to 86%; and 76%; 95% CI, 74% to 77%). Among men, cancer survivors were not significantly more likely than men without cancer to receive prostate exams (76%; 95% CI, 70% to 82%; and 69%; 95% CI, 67% to 71%, respectively), nor were they more likely to receive them after prostate cancer survivors were excluded (69%; 95% CI, 57% to 77%; and 69%; 95% CI, 67% to 71%, respectively).
The association between a cancer diagnosis and cancer screening differed by the amount of time a person had cancer. Within 5 years of diagnosis, cancer survivors were more likely than controls to have had cancer screening tests other than for prostate cancer. However, the only difference in cancer screening among longer-term survivors compared to no-cancer controls was for mammograms (86%; 95% CI, 78% to 92%; and 76%; 95% CI, 74% to 77%, respectively) (Table 4). Once participants with a history of the cancer associated with the screening test were excluded, there were few significant differences for short-term survivors and no significant differences for longer-term cancer survivors compared with no-cancer controls. The magnitude of the differences described remained when after-cancer provider and patient factors were included in the models.
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