摘要：Regular cancer screening can prevent the development of some cancers and increase patient survival for other cancers. We evaluated the reported cancer screening prevalence among a nationally representative sample of all US workers with data from the 2000 and 2005 Cancer Screening Supplements of the National Health Interview Survey. Overall, workers with the lowest rates of health insurance coverage (in particular, Hispanic workers, agricultural workers, and construction workers) reported the lowest cancer screening. There was no significant improvement from 2000 to 2005. The American Cancer Society 1 – 3 and other groups 4 recommend regular professional screening examinations for the prevention of cervical and colorectal cancer through removal of precancerous lesions and for the early detection of these and other cancers (e.g., breast, prostate) to reduce mortality ( Table 1 ). A key Healthy People 2010 objective is “to eliminate health disparities among segments of the population including differences that occur by gender, race, or ethnicity, geographic location, or sexual orientation.” 5 However, as noted by Barbeau et al., 6 occupation is not identified as a significant predictor of health disparities. We used a nationally representative database to examine health disparities and reported cancer screening behaviors of US workers in 2000 and 2005. TABLE 1 American Cancer Society Cancer Screening Recommendations for Years 2000 and 2005 and Healthy People 2010 Cancer Screening Recommendations Cancer Site Breast Cancer (Women) Colorectal Cancer Cervical Cancer (Women) Prostate Cancer (Men) American Cancer Society cancer screening recommendations for 2000 and 2005 ACS (2000) Clinical breast examination every 3 years, aged 20–39; annually, aged ≥ 40. Mammography annually, aged ≥ 40. Start at age 50. Annual fecal occult blood test and flexible sigmoidoscopy every 5 years, or double contrast barium enema, every 5–10 years, or colonoscopy every 10 years. Sexually active women or those ≥ 18 years, annual Pap test and pelvic examination. After more than 3 consecutive satisfactory normal annual examinations, the Pap test may be performed less frequently at the discretion of the physician. Annual digital rectal examination and PSA test should be offered to men starting at age 50. ACS (2005) Clinical breast examination as part of a periodic health examination, preferably at least every 3 years, aged 20–39; annually, ≥ 40 years. Mammography annually, age ≥ 40. Start at age 50. Fecal occult blood test, fecal immunochemical test annually, or flexible sigmoidoscopy or fecal occult blood test annually and flexible sigmoidoscopy, or double contrast barium enema every 5 years, or colonoscopy every 10 years. Begin approximately 3 years after a woman begins having vaginal intercourse, but no later than age 21. Every year with conventional Pap tests or every 2 years using liquid-based Pap tests. At or after age 30, women who have had 3 normal test results in a row may be screened every 2 to 3 years with cervical cytology alone, or every 3 years with a human papillomavirus DNA test plus cervical cytology. Women ≥ 70 years who have had 3 or more normal Pap tests and no abnormal Pap tests in the last 10 years and women who have had a total hysterectomy may choose to stop cervical cancer screening. Digital rectal examination and PSA test should be offered annually, starting at age 50, for men who have a life expectancy of at least 10 years. Healthy People 2010 objectives and target screening rates Objectives Reduce the breast cancer death rate. Increase the proportion of women ≥ 40 years who have received a mammogram within the preceding 2 years. Reduce the colon cancer death rate. Increase the proportion of adults who receive a colorectal cancer screening examination. Increase the proportion of women who receive a Pap test. Reduce the prostate cancer death rate. Baseline (1998) and target screening rates 67% of women ≥ 40 years received a mammogram within the preceding 2 years. Target: 70%. 35% of adults ≥ 50 years received a fecal occult blood test within the preceding 2 years. Target: 50%. 37% of adults ≥ 50 years have ever received a sigmoidoscopy. Target: 50%. 92% of women ≥ 18 years have ever received a Pap test. Target: 97%. 79% of women ≥ 18 years received a Pap test within the preceding 3 years. Target: 90%. Efforts aimed at reducing deaths through screening and early detection remain controversial because of the uncertain benefits and potential risks of screening, diagnosis, and treatment. Digital rectal examination and the PSA test are two commonly used methods for detecting prostate cancer. Open in a separate window Note. ACS = American Cancer Society; PSA = prostate-specific antigen; Pap = Papanicolaou.
