Journal
JOURNAL OF THE AMERICAN BOARD OF FAMILY MEDICINE
Volume 25, Issue 4, Pages 460-469Publisher
AMER BOARD FAMILY MEDICINE
DOI: 10.3122/jabfm.2012.04.110118
Keywords
Cancer Screening; Longitudinal Studies; Preventive Health Services; Prevention; Primary Health Care; Registries; Survivorship
Categories
Funding
- Agency for Health care Research and Quality (AHRQ)/National Research Service Award (NRSA) [T32 HS00083]
- National Cancer Institute [R21 CA137288]
- National Institute on Aging [P01 AG021079, R01 AG09775, R01 AG033285]
- University of Wisconsin Institute for Clinical and Translational Research (UWICTR)
- National Center for Research Resources
- National Institutes of Health [UL1 RR025011]
- National Institute on Aging Mentored Clinical Scientist Research Career Development Award [l K08 AG029527]
- Health Innovation Program
- Vilas Estate Trust
- National Science Foundation
- Spencer Foundation
- Graduate School of the University of Wisconsin-Madison
- Agency for Health care Research and Quality (AHRQ)
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Background: Although 64% of cancer survivors are expected to live at least 5 years beyond diagnosis, the receipt of cancer screening by this population is unclear. The objective of this study was to assess the relation between a cancer diagnosis and future cancer screening, exploring provider-, patient-, and cancer-specific factors that explain observed relationships. Methods: The Wisconsin Longitudinal Study (WLS) and Wisconsin Tumor Registry were used to identify 2 participant groups: 415 patients diagnosed with nonmetastatic cancer between 1992 to 1993 (before cancer) and 2003 to 2004 (after cancer) and 4680 controls (no cancer). Adjusted average predicted probabilities of cancer screening were estimated with models that first did not include and then included, provider (provider relationship length), participant (depressive symptoms per the Center for Epidemiologic Studies Depression Scale), and cancer-specific (time since diagnosis) factors. Participants with a history of cancer associated with a given screening test were then excluded to assess whether relationships are explained by screening for recurrence versus second cancers. Results: Female cancer survivors were more likely than no-cancer controls to undergo pelvic/Papanicolaou screening (survivors: 70%, 95% confidence interval [CI]: 63% to 76%; controls: 61%, 95% CI: 59% to 63%) and mammography screening (survivors: 86%, 95% CI: 78% to 90%; controls: 76%, 95% CI: 74% to 77%), though male cancer survivors were not more likely to receive prostate exams (survivors: 76%, 95% CI: 70% to 82%; controls: 69%, 95% CI: 67% to 71%). After excluding people with a history of the cancer being screened for, there were few significant differences in cancer screening between short- or long-term survivors (>= 5 years) and no-cancer controls. Relationships were not sensitive to adjustment for provider or participant factors. Conclusions: The significant positive differences in cancer screening between people with and without cancer can be explained by screening for recurrence. Long-term cancer survivors are not more likely to receive follow-up screening for second cancers. This information should be used by providers to ensure patients receive recommended follow-up preventive care. (J Am Board Fam Med 2012;25:460-469.)
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