Cancer screening in the United States, 2008: a review of current American Cancer Society guidelines and cancer screening issues

Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection and a summary of the most current data on cancer screening rates and trends in US adults. In 2007, the ACS updated its colorectal cancer screening guidelines in a collaborative effort with the US Multi-Society Task Force and the American College of Radiology. In this issue of the journal, we summarize the current ACS guidelines, provide an update of the most recent data pertaining to participation rates in cancer screening from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System and the National Health Interview Survey, and address some issues related to access to care.

Association of insurance with cancer care utilization and outcomes

Advances in the prevention, early detection, and treatment of cancer have resulted in an almost 14% decrease in the death rates from all cancers combined from 1991 to 2004 in the overall US population, with remarkable declines in mortality for the top 3 causes of cancer death in men (lung, colorectal, and prostate cancer) and 2 of the top 3 cancers in women (breast and colorectal cancer). However, not all segments of the population have benefited equally from this progress, and evidence suggests that some of these differences are related to lack of access to health care. Lack of adequate health insurance appears to be a critical barrier to receipt of appropriate health care services. This article provides an overview of systems of health insurance in the United States, demographic and socioeconomic characteristics associated with health insurance coverage, and economic burdens related to health care among individuals and families. This article also presents data on the association between health insurance status and screening, stage at diagnosis, and survival for breast and colorectal cancer based on analyses of the National Health Interview Survey and the National Cancer Data Base. Although this article focuses on associations between health insurance and cancer care utilization and outcomes, it is important to recognize that barriers to receipt of optimal cancer care are complex and involve patient-level, provider, and health system factors. Evidence presented in this paper suggests that addressing insurance and cost-related barriers to care is a critical component of efforts to ensure that all Americans are able to share in the progress that can be achieved by access to high-quality cancer prevention, early detection, and treatment services.

Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities

Many studies demonstrate that cancer incidence and mortality patterns among Asian Americans are heterogeneous, but national statistics on cancer for Asian ethnic groups are not routinely available. This article summarizes data on cancer incidence, mortality, risk factors, and screening for 5 of the largest Asian American ethnic groups in California. California has the largest Asian American population of any state and makes special efforts to collect health information for ethnic minority populations. We restricted our analysis to the 4 most common cancers (prostate, breast, lung, colon/rectum) and for the 3 sites known to be more common in Asian Americans (stomach, liver, cervix). Cancer incidence and mortality were summarized for 5 Asian American ethnic groups in California in order of population size (Chinese, Filipino, Vietnamese, Korean, and Japanese). Chinese Americans had among the lowest incidence and death rate from all cancer combined; however, Chinese women had the highest lung cancer death rate. Filipinos had the highest incidence and death rate from prostate cancer and the highest death rate from female breast cancer. Vietnamese had among the highest incidence and death rates from liver, lung, and cervical cancer. Korean men and women had by far the highest incidence and mortality rates from stomach cancer. Japanese experienced the highest incidence and death rates from colorectal cancer and among the highest death rates from breast and prostate cancer. Variations in cancer risk factors were also observed and were for the most part consistent with variations in cancer incidence and mortality. Differences in cancer burden among Asian American ethnic groups should be considered in the clinical setting and in cancer control planning.

Cancer screening in the United States, 2007: a review of current guidelines, practices, and prospects

Each year, the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, including guideline updates, emerging issues that are relevant to screening for cancer, and a summary of the most current data on cancer screening rates for US adults. In 2006, there were no updates to ACS guidelines for early cancer detection. In this issue of the journal, we describe criteria for successful screening, discuss recent evidence and policy changes that have implications for cancer screening, summarize the ACS guidelines and describe guidelines reviews that are underway, and provide an update of the most recent data pertaining to participation rates in cancer screening from the Centers for Disease Control and Prevention's (CDC's) Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS).

Associations of subsite-specific colorectal cancer incidence rates and stage of disease at diagnosis with county-level poverty, by race and sex

BACKGROUND

This study examined associations of subsite-specific colorectal cancer incidence rates and stage of the disease with county-level poverty.

METHODS

The 1998-2001 colorectal cancer incidence data, covering 75% of the United States population, were from 38 states and metropolitan areas. The county-level poverty data were categorized into 3 groups according to the percentage of the population below the poverty level in 1999: <10% (low-poverty), 10%-19% (middle-poverty), and >or=20% (high-poverty). Age-adjusted subsite-specific incidence rates (for all ages) and stage-specific incidence rates (for ages >or=50) were examined by race (whites and blacks), sex, and the county's poverty level. The differences in the incidence rates were examined using the 2-tailed z-statistic.

RESULTS

The incidence rates of proximal colon cancer were higher among white males (11% higher) and white females (15% higher) in the low-poverty than in the high-poverty counties. No differences across county poverty levels were observed among whites for distal colon and rectal cancers or among blacks for all the subsites. The late-to-early stage incidence rate ratios were higher in the high-poverty than in the low-poverty counties among white and black males for distal colon and rectal cancers, among white females for distal colon cancer, and among black females for rectal cancer. For proximal colon cancer, however, the late-to-early stage rate ratios were similar across all county poverty levels.

CONCLUSIONS

Higher incidence rates of proximal cancer were observed among white males and females in the low-poverty counties relative to the high-poverty counties. The higher late-to-early stage rate ratios in high-poverty than in low-poverty counties is observed for distal colon and rectal cancers, but not for proximal colon cancer.

Trends in sunburns, sun protection practices, and attitudes toward sun exposure protection and tanning among US adolescents, 1998-2004

BACKGROUND

Sun exposure in childhood is an important risk factor for developing skin cancer as an adult. Despite extensive efforts to reduce sun exposure among the young, there are no population-based data on trends in sunburns and sun protection practices in the young. The aim of this study was to describe nationally representative trend data on sunburns, sun protection, and attitudes related to sun exposure among US youth.

METHODS

Cross-sectional telephone surveys of youth aged 11 to 18 years in 1998 (N = 1196) and in 2004 (N = 1613) were conducted using a 2-stage sampling process to draw population-based samples. The surveys asked identical questions about sun protection, number of sunburns experienced, and attitudes toward sun exposure. Time trends were evaluated using pooled logistic regression analysis.

RESULTS

In 2004, 69% of subjects reported having been sunburned during the summer, not significantly less than in 1998 (72%). There was a significant decrease in the percentage of those aged 11 to 15 years who reported sunburns and a nonsignificant increase among the 16- to 18-year-olds. The proportion of youth who reported regular sunscreen use increased significantly from 31% to 39%. Little change occurred in other recommended sun protection practices.

CONCLUSIONS

A small reduction in sunburn frequency and modest increases in sun protection practices were observed among youth between 1998 and 2004, despite widespread sun protection campaigns. Nevertheless, the decrease in sunburns among younger teens may be cause for optimism regarding future trends. Overall, there was rather limited progress in improving sun protection practices and reducing sunburns among US youth between 1998 and 2004.

Progress and opportunities in tobacco control

Much progress has been made in reducing tobacco use in the United States. Despite the continuing challenges of tobacco control and the massive burden of illness, death, and economic costs caused by tobacco products, there are now unprecedented opportunities to prevent and treat tobacco dependence through a combination of interventions that have proven effective at both the population and individual levels. This report briefly reviews population trends in tobacco use by youth and adults, describes some of the policy measures that have proven effective in comprehensive tobacco control, and discusses the role of clinicians in the diagnosis and treatment of tobacco dependence in patients.

Trends in breast cancer by race and ethnicity: update 2006

In this article, the American Cancer Society (ACS) provides estimates of new breast cancer cases and deaths in 2006 and describes trends in incidence, mortality, and survival for female breast cancer in the United States. These estimates are based on incidence data from the National Cancer Institute (NCI) and the North American Association of Central Cancer Registries, which includes state data from NCI and the National Program of Cancer Registries of the Centers for Disease Control and Prevention and mortality data from the National Center for Health Statistics for the most recent years available (1975 to 2002). This article also shows trends in screening mammography. Approximately 212,920 new cases of invasive breast cancer, 61,980 in situ cases, and 40,970 deaths are expected to occur among US women in 2006. As previously reported, breast cancer incidence rates increased rapidly among women of all races from 1980 to 1987, a period when there was increasing uptake of mammography by a growing proportion of US women, and then continued to increase, but at a much slower rate, from 1987 to 2002. Trends in incidence vary by age, race, socioeconomic status, and stage. The continuing increase in incidence (all stages combined) is limited to White women age 50 and older; recent trends are stable for African American women age 50 and older and White women under age 50 years and are decreasing for African American women under age 50 years. Although incidence rates (all races combined) are substantially higher for women age 50 and older (375.0 per 100,000 females) compared with women younger than 50 years (42.5 per 100,000 females), approximately 23% of breast cancers are diagnosed in women younger than 50 years because those women represent 73% of the female population. For women age 35 and younger, age-specific incidence rates are slightly higher among African Americans compared with Whites but then cross over so that Whites have substantially higher incidence at all later ages. Among women of all races and ages, breast cancer mortality rates declined at an average rate of 2.3% per year between 1990 and 2002, a trend that reflects progress in both early detection and treatment. However, death rates in African American women remain 37% higher than in Whites, despite lower incidence rates. Although, in national surveys, approximately 70% of women age 40 years and older report having had a mammogram in the past 2 years, rates vary by race/ethnicity and are markedly lower among women with lower levels of education, without health insurance, and in recent immigrants. Furthermore, a recent study suggests that the true percentage of women having regular mammography is lower than reported in survey data. Encouraging patients age 40 years and older to have annual mammography and clinical breast exam is the single most important step that clinicians can take to reduce suffering and death from breast cancer. Clinicians should also ensure that patients at high risk of breast cancer are identified and offered appropriate referrals and treatment. Continued progress in the control of breast cancer will require sustained and increased efforts to provide high-quality screening, diagnosis, and treatment to all segments of the population.

American Cancer Society guidelines for the early detection of cancer, 2006

Each January, the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, including guideline updates, emerging issues that are relevant to screening for cancer, and a summary of the most current data on cancer screening rates for US adults. In 2005, there were no updates to ACS guidelines. In this issue of the journal, we summarize the guidelines, discuss recent evidence and policy changes that have implications for cancer screening, and provide an update of the most recent data pertaining to participation rates in cancer screening by age, sex, and insurance status from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System.

Annual report to the nation on the status of cancer, 1975–2003, featuring cancer among U.S. Hispanic/Latino populations

BACKGROUND

The American Cancer Society, Centers for Disease Control and Prevention, National Cancer Institute, and North American Association of Central Cancer Registries collaborate annually to provide U.S. cancer information, this year featuring the first comprehensive compilation of cancer information for U.S. Latinos.

METHODS

Cancer incidence was obtained from 90% of the Hispanic/Latino and 82% of the U.S. populations. Cancer deaths were obtained for the entire U.S. population. Cancer screening, risk factor, incidence, and mortality data were compiled for Latino and non-Latino adults and children (incidence only). Long-term (1975-2003) and fixed-interval (1995-2003) trends and comparative analyses by disease stage, urbanicity, and area poverty were evaluated.

RESULTS

The long-term trend in overall cancer death rates, declining since the early 1990s, continued through 2003 for all races and both sexes combined. However, female lung cancer incidence rates increased from 1975 to 2003, decelerating since 1991 and breast cancer incidence rates stabilized from 2001 to 2003. Latinos had lower incidence rates in 1999-2003 for most cancers, but higher rates for stomach, liver, cervix, and myeloma (females) than did non-Latino white populations. Latino children have higher incidence of leukemia, retinoblastoma, osteosarcoma, and germ-cell tumors than do non-Latino white children. For several common cancers, Latinos were less likely than non-Latinos to be diagnosed at localized stages.

CONCLUSIONS

The lower cancer rates observed in Latino immigrants could be sustained by maintenance of healthy behaviors. Some infection-related cancers in Latinos could be controlled by evidence-based interventions. Affordable, culturally sensitive, linguistically appropriate, and timely access to cancer information, prevention, screening, and treatment are important in Latino outreach and community networks.

American Cancer Society Guidelines for the Early Detection of Cancer, 2005

Each January, the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, including guideline updates, emerging issues that are relevant to screening for cancer, and a summary of the most current data on cancer screening rates for US adults. In 2004, there were no updates to ACS guidelines. In this article, we summarize the current guidelines, discuss recent evidence and policy changes that have implications for cancer screening, and provide an update of the most recent data pertaining to participation rates in cancer screening by age, gender, and insurance status from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System.

Underuse of screening sigmoidoscopy and colonoscopy in a large cohort of US adults

OBJECTIVES

We examined the prevalence of endoscopy (sigmoidoscopy or colonoscopy) by indication and by demographic and lifestyle factors.

METHODS

We analyzed cross-sectional data collected in 1997 from participants aged 50 years and older in the Cancer Prevention Study (CPS) II Nutrition Cohort.

RESULTS

Fifty-eight percent of men and 51% of women reported ever having undergone endoscopy; only 42% of men and 31% of women reported endoscopy for screening rather than for disease diagnosis or follow-up. Prevalence varied by demographic and lifestyle factors.

CONCLUSIONS

Efforts to increase colorectal cancer screening need to target women, all persons aged 50-64 years, and those with colorectal cancer risk factors. Future studies should distinguish endoscopy for screening from procedures for disease diagnosis and follow-up to avoid overestimating screening compliance.

A comparison of physical activity of posttreatment breast cancer survivors and noncancer controls

The authors obtained data from 335 breast cancer survivors and 6,880 noncancer controls. They proposed (1) to determine whether, after treatment, the survivors were meeting the Center for Disease Control and Prevention/American College of Sports Medicine recommendations for physical activity and were similar to the controls in physical activity and (2) to compare the modes of activity of the 2 groups in frequency, min/session, and sessions/wk. Adjusted logistic regression analyses revealed that the breast cancer survivors engaged in as much moderate, vigorous, and combined physical activity as the noncancer controls did. However, chi-square analyses showed that survivors engaged in more yard work than the controls did, whereas independent-sample t tests showed that the frequency and the total min/wk of stretching were significantly higher in breast cancer survivors compared with noncancer controls. Findings from the study suggest that breast cancer survivors engage in as much physical activity as controls do, but that the groups differ in specific activities.

Cigarette advertising and female smoking prevalence in Spain, 1982-1997

BACKGROUND

Compared with northern Europe and the U.S., the widespread initiation of cigarette smoking began 20-40 years later among young women in Spain because of strong cultural prohibitions against female smoking. In this study, the authors examined the correlation between the rapid increase in female smoking prevalence and tobacco industry cigarette marketing practices in Spain during a period of rapid social liberalization.

METHODS

The authors examined age-specific, period-specific, and birth cohort-specific increases in cigarette smoking among young women in Spain in relation to internal documents from Philip Morris beginning in 1971, cigarette advertising from 1982 to 1997, and the increase in the market share of blond tobacco and "light" cigarettes preferred by women.

RESULTS

Some increase in cigarette smoking occurred among Spanish women before 1970, but the increase was substantially smaller and occurred later than in many Western countries. However, after 1970, the prevalence of cigarette smoking increased rapidly in Spanish women of all ages < 50 years. The rapid increase in female smoking coincided with massive increases in television advertising, especially to women, and increases in the market share of blond tobacco, "light cigarettes," and international tobacco brands.

CONCLUSIONS

The increase in cigarette smoking among young Spanish women illustrates how aggressive marketing can exploit periods of social liberalization and rapidly increase cigarette smoking among women, even in countries in which female smoking traditionally has been unacceptable. Strategies are needed to prevent similar increases in smoking by women elsewhere.

Cancer disparities by race/ethnicity and socioeconomic status

This article highlights disparities in cancer incidence, mortality, and survival in relation to race/ethnicity, and census data on poverty in the county or census tract of residence. The incidence and survival data derive from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) Program; mortality data are from the National Center for Health Statistics (NCHS); data on the prevalence of major cancer risk factors and cancer screening are from the National Health Interview Survey (NHIS) conducted by NCHS. For all cancer sites combined, residents of poorer counties (those with greater than or equal to 20% of the population below the poverty line) have 13% higher death rates from cancer in men and 3% higher rates in women compared with more affluent counties (less than 10% below the poverty line). Differences in cancer survival account for part of this disparity. Among both men and women, five-year survival for all cancers combined is 10 percentage points lower among persons who live in poorer than in more affluent census tracts. Even when census tract poverty rate is accounted for, however, African American, American Indian/Alaskan Native, and Asian/Pacific Islander men and African American and American Indian/Alaskan Native women have lower five-year survival than non-Hispanic Whites. More detailed analyses of selected cancers show large variations in cancer survival by race and ethnicity. Opportunities to reduce cancer disparities exist in prevention (reductions in tobacco use, physical inactivity, and obesity), early detection (mammography, colorectal screening, Pap tests), treatment, and palliative care.

American Cancer Society guidelines for the early detection of cancer, 2004

Each January, the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, including updates, emerging issues that are relevant to screening for cancer, or both. In the spring of 2003, the ACS announced updated guidelines for breast cancer screening, and several other organizations released updated guidelines that we compare with recent ACS updates. Finally, the most recent data pertaining to participation rates in cancer screening are presented by age and sex from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, as are U.S. maps profiling states based on the proportion of the age-eligible population not recently screened for breast cancer or colorectal cancer.

Trends in breast cancer by race and ethnicity

In this article, the American Cancer Society (ACS) describes trends in incidence, mortality, and survival rates of female breast cancer in the United States by race and ethnicity. It also provides estimates of new cases and deaths and shows trends in screening mammography. The incidence and survival data derive from the National Cancer Institute's Surveillance, Epidemiology, and End Results program; mortality data are from the National Center for Health Statistics. Approximately 211,300 new cases of invasive breast cancer, 55,700 in situ cases, and 39,800 deaths are expected to occur among women in the United States in 2003. Breast cancer incidence rates have increased among women of all races combined and white women since the early 1980s. The increasing rate in white women predominantly involves small (< or = 2 cm) and localized-stage tumors, although a small increase in the incidence of regional-stage tumors and those larger than five cm occurred since the early 1990s. The incidence rate among African American women stabilized during the 1990s for all breast cancers and for localized tumors. African American women are more likely than white women to be diagnosed with large tumors and distant-stage disease. Other racial and ethnic groups have lower incidence rates than do either white or African American women. However, the proportion of disease diagnosed at advanced stage and with larger tumor size in all minorities is greater than in white persons. Death rates decreased by 2.5% per year among white women since 1990 and by 1% per year among African American women since 1991. The disparity in mortality rates between white and African American women increased progressively between 1980 and 2000, so that by 2000 the age-standardized death rate was 32% higher in African Americans. Clinicians should be aware that 63% and 29% of breast cancers are diagnosed at local- and regional-stage disease, for which the five-year relative survival rates are 97% and 79%, respectively. This information, coupled with decreasing mortality rates and improvements in treatment, may motivate women to have regular mammographic and clinical breast examinations. Continued efforts are needed to increase the availability of high-quality mammography and treatment to all segments of the population.

Cancer statistics for Hispanics, 2003

In this article, the American Cancer Society (ACS) provides estimates on the number of new cancer cases and deaths, and compiles health statistics on the US Hispanic population. The compiled statistics include cancer incidence, mortality, and behaviors relevant to cancer using the most recent data on incidence from the National Cancer Institute's (NCI) Surveillance, Epidemiolgy, and End Results (SEER) Program, mortality data from the National Center for Health Statistics, and behavioral information from the Behavior Risk Factor Surveillance System (Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System [BRFSS], Youth Risk Behavior Surveillance System [YRBSS], and National Health Interview Survey [NHIS].) An estimated 67,400 new cases of cancer and 22,100 cancer deaths will occur among Hispanics in 2003. Hispanics have lower incidence and death rates from all cancers combined and from the four most common cancers (breast, prostate, lung and bronchus, and colon and rectum) than non-Hispanic whites. However, Hispanics have higher incidence and mortality rates from cancers of the stomach, liver, uterine cervix, and gallbladder, reflecting in part greater exposure to specific infectious agents and lower rates of screening for cervical cancer, as well as dietary patterns and possible genetic factors. Strategies for reducing cancer risk among Hispanics include further development of effective interventions to increase screening and physical activity, reductions in tobacco use and obesity, and the development and application of effective vaccines.

American Cancer Society guidelines for the early detection of cancer, 2003

Each January, the American Cancer Society (ACS) publishes a summary of existing recommendations for early cancer detection, including updates, and/or emerging issues that are relevant to screening for cancer. In 2002, the ACS assembled expert groups to update guidelines for cervical cancer screening and breast cancer screening, and to evaluate new technology for colorectal cancer screening. In November 2002, updated guidelines for cervical cancer screening were published in this journal, and breast cancer screening guidelines will be updated in 2003. In this issue, there is a report of a workshop held to review emerging technology for colorectal cancer screening that resulted in a modification of current previous recommendations for fecal occult blood tests, and revised recommendations for the "cancer-related check-up" in which clinical encounters provide case-finding and health-counseling opportunities. Finally, we provide an update of the most recent data pertaining to participation rates in cancer screening by age, gender, and ethnicity from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS).

Cancer statistics for African Americans

The American Cancer Society provides estimates on the number of new cancer cases and deaths, and compiles health statistics on African Americans in a biennial publication, Cancer Facts and Figures for African Americans. The compiled statistics include cancer incidence, mortality, survival, and lifestyle behaviors using the most recent data on incidence and survival from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program, mortality data from the National Center for Health Statistics (NCHS), and behavioral information from the Behavior Risk Factor Surveillance System (BRFSS), Youth Risk Behavior Surveillance System (YRBSS), and National Health Interview Survey (NHIS). It is estimated that 132,700 new cases of cancer and 63,100 deaths will occur among African Americans in the year 2003. Although African Americans have experienced higher incidence and mortality rates of cancer than whites for many years, incidence rates have declined by 2.7 percent per year in African-American males since 1992, while stabilizing in African-American females. During the same period, death rates declined by 2.1 percent and 0.4 percent per year among African-American males and females, respectively. The decrease in both incidence and death rates from cancer among African-American males was the largest of any racial or ethnic group. Nonetheless, African Americans still carry the highest cancer burden among US racial and ethnic groups. Most cancers detectable by screening are diagnosed at a later stage and survival rates are lower within each stage of disease in African Americans than in whites. The extent to which these disparities reflect unequal access to health care versus other factors is an active area of research.

Case studies in international tobacco surveillance: cigarette smuggling in Brazil

OBJECTIVE

This article is the first in a series of international case studies developed by the American Cancer Society to illustrate use of publicly available surveillance data for regional tobacco control.

DESIGN

A descriptive analysis of Brazil and Paraguay cigarette production and trade data from official sources.

METHODS

Per capita cigarette consumption for Brazil and its neighbour was calculated from 1970 to 1998 using data on production, imports, and exports from NATIONS, the National Tobacco Information Online System.

RESULTS

A 63% decrease was observed in the estimate of per capita consumption of cigarettes in Brazil between 1986 and 1998 (from 1913 cigarettes per person in 1986 to 714 cigarettes per person in 1998) and a 16-fold increase in Paraguay was observed during the same period (from 678 cigarettes per person in 1986 to 10 929 cigarettes per person in 1998). Following Brazil's 1999 passage of a 150% cigarette export tax, cigarette exports fell 89% and Brazil's estimated per capita consumption rose to 1990 levels (based on preliminary data). Per capita consumption in Paraguay also fell to 1990 levels.

CONCLUSIONS

These trends coincide with local evidence that large volumes of cigarettes manufactured in Brazil for export to Paraguay are smuggled back and consumed as tax-free contraband in Brazil. It is hoped that this case study will draw wider public attention to the problems that smuggling presents for tobacco control, help identify other countries confronting similar issues, and stimulate effective interventions.

American Cancer Society guidelines for the early detection of cancer

Each year the American Cancer Society publishes a summary of existing recommendations for early cancer detection, including updates, and/or emerging issues that are relevant to screening for cancer. In last year's article, the guidelines regarding screening for the early detection of prostate, colorectal, and endometrial cancers were updated, as was the narrative pertaining to testing for early lung cancer detection. Although none of the ACS's guidelines were updated in 2001, work is proceeding on an update of screening recommendations for breast and cervical cancer and an update of these guidelines will be announced in the January/February 2003 issue of CA. As in previous issues, we review recommendations for the "cancer-related check-up," in which clinical encounters provide case-finding and health counseling opportunities. Finally, we provide an update of the most recent data pertaining to participation rates in cancer screening by age, gender, and ethnicity from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS) and National Health Interview Survey (NHIS).

Health insurance coverage-enrollment and adequacy of prenatal care utilization

Most studies have concluded that good prenatal care plays an essential role in improving birth outcomes, and numerous reports have documented barriers to adequate prenatal care. The relationship between health care insurance eligibility and enrollment procedures and adequacy of prenatal care, however, has not been suitably investigated. This study used data from a statewide representative sample of recently delivered women in South Carolina to assess (1) patterns of health care insurance source and (2) the independent effects of Medicaid enrollment and application procedures on receipt of prenatal care. Health insurance during pregnancy varied by sociodemographic characteristics. Black women's experiences with Medicaid enrollment and application procedures were associated with less than adequate prenatal care. Programmatic efforts and policies should emphasize further improvement in the systems of health care access and delivery to disadvantaged women.

American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. Also: update 2001--testing for early lung cancer detection

Updates to the American Cancer Society (ACS) guidelines regarding screening for the early detection of prostate, colorectal, and endometrial cancers, based on the recommendations of recent ACS workshops, are presented. Additionally, the authors review the "cancer-related check-up," clinical encounters that provide case-finding and health counseling opportunities. Finally, the ACS is issuing an updated narrative related to testing for early lung cancer detection for clinicians and individuals at high risk of lung cancer in light of emerging data on new imaging technologies. Although it is likely that current screening protocols will be supplanted in the future by newer, more effective technologies, the establishment of an organized and systematic approach to early cancer detection would lead to greater utilization of existing technology and greater progress in cancer control.