Cancer screening estimates for U.S. metropolitan areas

Abstract

Objectives

To provide estimates of breast, cervical, and colorectal cancer screening for metropolitan areas in the United States.

Methods

Behavioral Risk Factor Surveillance System (BRFSS) data from 1997 to 1999 were reweighted and analyzed for 69 U.S. metropolitan areas for the receipt of a Papanicolaou (Pap) test (ages ≥18 years); mammography (ages ≥40 years); fecal occult blood testing and sigmoidoscopy (ages ≥50 years). Stratified analyses by demographics were performed for 25 metropolitan areas with populations of ≥1.5 million.

Results

Metropolitan estimates ranged from 64.6% to 82.0% for mammography and from 77.2% to 91.7% for Pap tests. There was much greater variability in estimates for colorectal cancer screening, with a 3.6-fold difference in the range of estimates for fecal occult blood testing (9.9% to 35.2%) and a 2.5-fold difference for sigmoidoscopy (17.3% to 43.3%). In the 25 largest areas, prevalence of cancer screening was generally lower for persons with a high school education or less and for those without health insurance. Compared with women aged 50 to 64 years, mammography estimates were lower for women aged 40 to 49 years in 13 of the 25 metropolitan areas. Pap testing was less common among women aged ≥65 years, and colorectal cancer screening was less common for persons aged 50 to 64 years.

Conclusions

Estimates of cancer screening varied substantially across metropolitan areas. Increased efforts to improve cancer screening are needed in many urban areas, especially for colorectal cancer screening. The BRFSS is a useful, inexpensive, and timely resource for providing metropolitan-area cancer screening estimates and may be used in the future to guide local or county-level screening efforts.

Introduction

S creening has been found to reduce morbidity and premature mortality from cervical, breast, and colorectal cancer.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 The National Health Interview Survey12, 13, 14 and the Behavioral Risk Factor Surveillance System (BRFSS)15, 16 provide national and state estimates for receipt of cancer screening among adults. Although there have been efforts in Los Angeles County and elsewhere,17, 18, 19, 20, 21, 22, 23, 24, 25, 26 metropolitan-level estimates for cancer screening are not widely available. Conducting surveys is expensive, and many health departments lack resources or infrastructure to collect such data.

The lack of urban data on cancer screening is unfortunate. Sociodemographics of urban areas differ from those of states; most urban areas have a higher concentration of racial/ethnic minority populations, who also are over-represented among the poor.27 Participation in cancer screening programs is low among many inner-city populations,28, 29, 30, 31, 32 and national and state estimates may mask such differences.33, 34 Relevant data can be used to help empower communities to address their own health issues,33, 34, 35, 36 especially as many efforts to improve cancer screening occur locally,37, 38, 39, 40, 41 and these data can help track progress toward Healthy People 2010 goals.42 One source for obtaining metropolitan area data is the BRFSS,43, 44 as the Centers for Disease Control and Prevention (CDC) recently reweighted BRFSS data for metropolitan areas based on county of residence.45

For this study, the overall prevalence estimates for the receipt of a Papanicolaou (Pap) test, mammography, and colorectal cancer screening (fecal occult blood test [FOBT] and sigmoidoscopy) were determined for metropolitan areas with sufficient sample sizes. Screening estimates were then compared by age, gender, race/ethnicity, education level, and health insurance status for the 25 largest metropolitan areas.