viernes, 28 de enero de 2011
Cancer Screening and Diagnosis
Less than 25 percent of physicians report guideline-consistent recommendations for cervical cancer screening.
Description: Researchers used a large, nationally representative sample of primary care physicians to identify current Pap test screening practices in 2006-2007. They used clinical vignettes to describe women by age and sexual and screening history to elicit physicians' recommendations. Guideline-consistent recommendations varied by physician specialty: obstetrics/gynecology 16.4 percent, internal medicine 27.5 percent, and family/general practice 21.1 percent.
Source: Yabroff, Saraiya, Mesisner, et al., Ann Intern Med 151(9):602-611, 2009 (AHRQ grant HS10565).
A majority of older women think lifelong cervical cancer screening is important.
Description: Researchers conducted face-to-face interviews with 199 women aged 65 and older to determine their views about continuing to receive Pap tests to screen for cervical cancer. Most of the women were minorities, and about 45 percent were Asian. Despite recent changes in clinical recommendations to stop Pap screening in women older than 65, more than two thirds of the women in this study felt that lifelong screening was either important or very important. Most of the women (77 percent) planned on being screened for the rest of their lives.
Source: Sawaya, Iwaoka-Scott, Kim, et al., Am J Obstet Gynecol 200(1):40.e1-40.e7, 2009. See also Huang, Perez-Stable, Kim, et al., J Gen Intern Med 23(9):1324-1329, 2008 (AHRQ grant HS10856).
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 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. The recommendation and materials for clinicians and patients are available at http://www.uspreventiveservicestaskforce.org/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. Effectiveness of Noninvasive Diagnostic Tests for Breast Abnormalities, Executive Summary No. 2 (AHRQ Publication No. 06-EHC005-1)*. There is also a update of this report online at
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For more information on AHRQ initiatives related to women's health, please contact:
Beth Collins Sharp, Ph.D., R.N.
Senior Advisor, Women's Health and Gender Research
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
For more information about AHRQ and its research portfolio and funding opportunities, visit the Agency's Web site at http://www.ahrq.gov.
Return to Contents
AHRQ Publication No. 11-P004
Replaces Publication No. 09-PB004
Current as of January 2011
Cancer Screening and Treatment in Women: Recent Findings. Program Brief. Agency for Healthcare Research and Quality, Rockville, MD. AHRQ Publication No. 11-P004, January 2011. http://www.ahrq.gov/research/cancerwom.htm
Cancer Screening and Treatment in Women: Program Brief (continued)