Cancer Screening and Treatment in Women: Recent Findings
Other Cancers
Women's perception of risk affects screening for colon cancer but not cervical or breast cancer.
Description: Researchers interviewed 1,160 white, black, Hispanic, and Asian women (aged 50 to 80) about their perceived risk for breast, cervical, and colon cancer and compared their perceived risk with their screening behavior. The women's perceived lifetime risk of cancer varied by ethnicity, with Asian women generally perceiving the lowest risk and Hispanic women the highest risk for all three types of cancer. Nearly 90 percent of women reported having a mammogram, and about 70 percent of the women reported having a Pap test in the previous 2 years; 70 percent of the women were current with colon cancer screening. There was no relationship between screening and perception of risk for cervical or breast cancer; however, a moderate to very high perception for colon cancer risk was associated with nearly three times higher odds of having undergone colonoscopy within the last 10 years.
Source: Kim, Perez-Stable, Wong, et al., Arch Int Med 168(7):728-734, 2008 (AHRQ grant HS10856).
Among older patients with early-stage lung cancer, women live longer than men, regardless of treatment choice.
Description: Researchers examined differences between women and men in the natural history of lung cancer, after controlling for unrelated causes of death and type of treatment among 18,967 Medicare patients with stages I and II non-small cell lung cancer who were diagnosed between 1991 and 1999. They found that the women lived longer than the men, regardless of the type of treatment they received, and that the women's longer survival was independent of
differences in life expectancy between men and women due to unrelated causes of death. They found improved survival advantages even among untreated women, suggesting that lung cancer in women has a different natural history and potentially a different tumor biology.
Source: Wisnivesky and Halm, J Clin Oncol 25(13):1705-1712, 2007 (AHRQ grant HS13312).
Up to 12 percent of tissues examined by pathologists for cancer result in diagnostic errors, many involving women.
Description: Researchers examined pathology errors over a 1-year period in patients at four hospitals who underwent laboratory tests to determine the presence or absence of cancer or precancerous lesions. Cancer diagnosis errors were dependent on the hospital and ranged from approximately 2 to 20 percent of gynecologic cases and from approximately 5 to 12 percent of nongynecologic cases. Errors due to pathologic misinterpretation ranged from 5 to 51 percent. The remaining errors were due to clinical sampling problems. Overall, 45 percent of gynecologic pathology errors were associated with harm. The researchers estimate that each year, nearly 128,000 U.S. patients will suffer harm as a result of cancer diagnosis errors.
Source: Raab, Grzybicki, Janosky, et al. Cancer 104(10):2205-2213, 2005 (AHRQ grant HS13321).
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Cancer Screening and Diagnosis
Requirement for cost-sharing reduces use of mammography among some groups of women.
Description: Researchers examined data on mammography use and cost-sharing from 2002 to 2004 for more than 365,000 women covered by Medicare. Of the 174 Medicare health plans studied, just 3 required copyaments of $10 or more or coinsurance of more than 20 percent in 2001; by 2004, 21 plans required cost-sharing of one form or another. The increase in coinsurance requirements correlated with a decrease in screening mammograms. Less than 70 percent of women in cost-sharing plans were screened, compared with nearly 80 percent of fully covered women. Although every demographic group was affected, black women and women with lower incomes and educations levels often were covered by plans that required cost-sharing.
Source: Trivedi, Rakowski, and Ayanian, N Engl J Med 358(4):375-383, 2008 (AHRQ grant T32 HS00020).
Breast screening is less common in counties that have many uninsured women.
Description: Researchers used data from two large surveillance systems to determine whether screening for breast cancer varied by the proportion of uninsured women in the community. The data showed that as the rate of uninsurance in a community increased by 5 percent, women were 5 percent less likely to receive either clinical breast exams or mammograms. Breast cancer screening declined significantly for women earning $25,000 to $75,000 who lived in counties with high rates of uninsurance. On the other hand, black women and Hispanic women had higher screening rates than white women when they lived in communities with low rates of uninsurance.
Source: Schootman, Walker, Jeffe, et al., Am J Prevent Med 33(5):379-386, 2007 (AHRQ grant HS14095).
Women aged 40 to 49 were responsive to changes in mammography recommendations.
Description: According to interviews with 1,451 women who received screening mammograms at one of five hospital-based clinics between October 1996 and January 1998, opinions about mammography have changed among women aged 40 to 49. Prior to the issuance of recommendations by the American Cancer Society and the National Cancer Institute that women aged 40 to 49 should receive screening mammograms every 1 or 2 years, only 49 percent of women in this age group endorsed annual screening. After the new recommendations were issued, 64 percent of women in this age group endorsed annual screening.
Source: Calvocoressi, Sun, Kasl, et al., Cancer 120(3):473-480, 2008 (AHRQ grant HS11603).
Task Force recommends against routine testing for genetic risk of breast or ovarian cancer.
Description: According to the U.S. Preventive Services Task Force, primary care physicians should only refer certain women for genetic counseling and DNA testing to detect the presence of specific BRCA1 and BRCA2 gene
mutations that may be associated with breast and ovarian cancer. Physicians should suggest counseling and DNA testing only for women who have specific family history patterns which put them at risk for these gene mutations.
Source: Nelson, Huffman, Fu, and Harris, Ann Intern Med 132(5):362-379, 2005; also look at pages 355-361 in the same journal (AHRQ contract 290-97-0011).
Task Force revises recommendations for mammography.
Description: The U.S. Preventive Services Task Force updated its recommendation by calling for screening mammography, with or without clinical breast exam, every 1 to 2 years for women 40 and over. The recommendation acknowledges some risks associated with mammography, which will lessen as women age. The strongest evidence of benefit and reduced mortality from breast cancer is among women ages 50 to 69.
Source: The recommendation and materials for clinicians and patients are available at
http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm (Intramural).
Noninvasive tests may miss breast cancer.
Description: This report indicates that four common noninvasive tests for breast cancer are not accurate enough to replace biopsies for women who receive abnormal findings from mammography or a clinical breast exam. Researchers found that each of the four tests—magnetic resonance imaging (MRI), ultrasonography (ultrasound), positron emission tomography scanning (PET scan), and scintimammography (nuclear medicine scan)—would miss a significant number of cases of cancer, compared with immediate biopsy, in women at high enough risk to warrant evaluation for breast cancer..
Source: Effectiveness of Noninvasive Diagnostic Tests for Breast Abnormalities, Executive Summary No. 2 (AHRQ Publication No. 06-EHC005-1)* and online at http://www.effectivehealthcare.ahrq.gov.
Researchers evaluate the costs and benefits of breast cancer screening of older women.
Description: The optimal age to stop breast cancer screening has not been determined. This study found that lifetime screening is not cost effective at $151,434 per life year saved if women receive idealized treatment (treatment and survival that are comparable to clinical trials). The researchers used a model to simulate the life history of women to evaluate the incremental societal costs and benefits of biennial screening from age 50 to age 70, to age 79, and for lifetime. The researchers concluded that if all women received idealized treatment, the benefits of mammography beyond age 79 would be too low relative to cost to justify continued screening.
Source: Mandelblatt, Schechter, Yabroff, et al. J Gen Intern Med 20:487-96, 2005 (AHRQ Publication No. 05-R072) (Intramural).*
Study reveals shortage of radiologists at community mammography facilities.
Description: In a 2000-2001 survey of mammography facilities in three States, nearly half of the 45 facilities reported radiologist staffing shortages. Almost two-thirds (60 percent) of not-for-profit facilities reported shortages, compared with less than one-third (28 percent) of for-profit facilities. Waiting times for diagnostic mammography ranged from less than 1 week to 4 weeks. Forty-seven percent of facilities had a waiting time of 2 or more weeks for screening mammography, and some had waiting times of 1 to 2 months.
Source: Orsi, Tu, Nakano, et al. Radiology 235:391-5, 2005 (AHRQ grant HS10591).
White women who are obese may avoid having Pap tests.
Description: This study found that white women who are obese are more likely than normal-weight white women to delay Pap testing and to find Pap tests to be painful, uncomfortable, and/or embarrassing. The researchers examined Pap testing in the preceding 3 years for 6,419 white women, 1,715 black women, and 1,859 Hispanic women aged 18 to 75 years. Overall, 86 percent of white, 88 percent of black, and 78 percent of Hispanic women reported Pap testing in the previous 3 years. After accounting for other factors, white women who were extremely obese (BMI greater than 40) were 9
percent less likely to have a Pap test compared with white women who were normal weight. BMI was not associated with screening in black or Hispanic women.
Source: Wee, Phillips, and McCarthy, Obes Res 13(7):1275-1280, 2005 (AHRQ grant HS11683).
Up to 12 percent of tissues examined by pathologists for cancer result in diagnostic errors.
Description: Researchers examined pathology errors over a 1-year period in patients at four hospitals who underwent laboratory tests to determine the presence or absence of cancer or precancerous lesions. Cancer diagnosis errors were dependent on the hospital and ranged from approximately 2 to 20 percent of gynecologic cases and from approximately 5 to 12 percent of nongynecologic cases. Errors due to pathologic misinterpretation ranged from 5 to 51 percent. The remaining errors were due to clinical sampling problems. Overall, 45 percent of gynecologic pathology errors and 39 percent of nongynecologic errors were associated with harm. The researchers estimate that nearly 128,000 patients per year in the United States will suffer harm as a result of cancer diagnosis errors.
Source: Raab, Grzybicki, Janosky, et al., Cancer 104(10):2205-2213, 2005 (AHRQ grant HS13321).
* Items marked with an asterisk are available free from the AHRQ Clearinghouse. To order, contact the Clearinghouse at 800-358-9295 or request electronically by sending an E-mail to ahrqpubs@ahrq.hhs.gov. Please use the AHRQ publication number when ordering.
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More Information
For more information on AHRQ initiatives related to women's health, please contact:
Shakeh J. Kaftarian, Ph.D.
Senior Advisor, Women's Health and Gender Research
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
Telephone: 301-427-1550
E-mail: Jackie.Kaftarian@ahrq.hhs.gov
Select for more information about AHRQ's research portfolio and funding opportunities.
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AHRQ Publication No. 09-PB004
Replaces Publication No. 06-P015
Current as of April 2009
Internet Citation:
Cancer Screening and Treatment in Women: Recent Findings. Program Brief. Agency for Healthcare Research and Quality, Rockville, MD. AHRQ Publication No. 09-PB004, April 2009. http://www.ahrq.gov/research/cancerwom.htm
540 Gaither Road Rockville, MD 20850