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.2007 Mar 26;167(6):580-5.
doi: 10.1001/archinte.167.6.580.

Delivery of cancer screening: how important is the preventive health examination?

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Delivery of cancer screening: how important is the preventive health examination?

Joshua J Fenton et al. Arch Intern Med..

Abstract

Background: Patients and physicians strongly endorse the importance of preventive or periodic health examinations (PHEs). However, the extent to which PHEs contribute to the delivery of cancer screening is uncertain.

Methods: In a retrospective cohort study, we determined the association between receipt of a PHE and cancer testing in a population-based sample of enrollees in a Washington State health plan who were aged 52 to 78 years and eligible for colorectal, breast, or prostate cancer screening in 2002-2003 (N = 64 288). Outcomes included completion of any colorectal cancer testing (fecal occult blood testing, sigmoidoscopy, colonoscopy, or barium enema), screening mammography, and prostate-specific antigen testing.

Results: More than half (52.4%) of the enrollees received a PHE during the study period. After adjusting for demographics, comorbidity, number of outpatient visits, and historical preventive service use before January 1, 2002, receipt of a PHE was significantly associated with completion of colorectal cancer testing (incidence difference, 40.4% [95% confidence interval (CI), 39.4%-41.3%]; relative incidence, 3.47 [95% CI, 3.34-3.59]), screening mammography [incidence difference, 14.2% [95% CI, 12.7%-15.7%]; relative incidence, 1.23 [95% CI, 1.20-1.25]), and prostate-specific antigen testing (incidence difference, 39.4% [95% CI, 38.3%-40.5%]; relative incidence, 3.06 [95% CI, 2.95-3.18]).

Conclusions: Among managed care enrollees eligible for cancer screening, PHE receipt is associated with completion of colorectal, breast, and prostate cancer testing. In similar populations, the PHE may serve as a clinically important forum for the promotion of evidence-based colorectal cancer and breast cancer screening and of screening with relatively less empirical support, such as prostate cancer screening.

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Figure
Figure
Adjusted incidence of any colorectal cancer tests (A), screening mammography (B), and prostate-specific antigen tests (C) in patients who did and did not receive preventive health examinations (PHEs) by the total number of outpatient visits (2002–2003). Incidence is adjusted for age (5-year categories), sex (for colorectal cancer testing), comorbidity (Charlson comorbidity index score of 0, 1, 2, or ≥3), historical PHE receipt (in 2000–2001), number of target organ cancer tests in 2000–2001 (0, 1, or ≥2), benign prostatic hyperplasia diagnosis in 2000–2003 (for prostate-specific antigen testing), and significant interactions between PHE receipt and the listed covariates (P<.05). For each cancer test, likelihood ratio tests of the interaction between PHE receipt and the number of outpatient visits were significant (P<.001).
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