Progress in Chronic Disease Prevention Provisional Estimates from the National Health Interview Survey Supplement on Cancer Control -- United States, January-March 1987

The National Center for Health Statistics (NCHS) and the National Cancer Institute (NCI) collaborated in conducting the 1987 National Health Interview Survey (NHIS) Supplement on Cancer Control. The early detection of cancer is an essential element in reaching the NCI's year 2000 goals for cancer reduction (1). The cancer screening component of this supplemental questionnaire to the survey provides a baseline for measuring the public's knowledge and use of cancer screening procedures.

Provisional estimates based on data from 5,723 adults interviewed during the first 3 months of 1987 provide a preliminary review of aggregate, race-, and sex-specific patterns in the knowledge and use of screening procedures for specific cancer sites.

NCI's early detection guidelines (2) suggest that women should begin having annual Pap smears at approximately 18 years of age (sooner if sexually active) to detect cervical cancer at an early stage. After three or more consecutive normal smears, the Pap test may be performed less frequently at the discretion of the woman's physician. The NHIS data indicate that information about the procedure has been well disseminated among both blacks and whites; only 3% of all female respondents reported that they had never heard of a Pap smear. However, 6% of the women who reported hearing of the procedure had never had one. Although 91% of the women respondents reported that they had had one or more Pap smears, at least 10% of these tests were performed because of health problems. Of the 81% who reported that their last Pap smear was for screening purposes, approximately three-fifths of the women had had the procedure within the past year.

A physical examination of the breast for the purpose of detecting breast cancer early is a recommended component of periodic health examinations for all women aged 40 and over. Whereas very few women (roughly 8%) reported that they had never heard of this examination, there were racial differences within this group. Blacks (85%) were less likely than whites (92%) to know about the examination (p less than 0.001). Even among those who knew of the examination, 14% of the blacks had never had it, compared with 8% of the whites (p = 0.016). A majority of women used this examination as a screening procedure (72%); 44% of all these women had done so in the past year.

According to the NCI working guidelines, mammography is encouraged every 1-2 years for women aged 40-49 and recommended annually for women aged 50 and over in addition to physical breast examinations (2). Of women aged 40 and over, approximately 45% had heard of but never had a mammogram. (Data for this age group are shown in Table 1.) In the group aged 50 and over, strong racial differences were observed concerning knowledge and use of this procedure. Although about 54% of the women in this age group had heard of but never had this procedure, the percentage of women who had never heard of this test was two times higher among blacks than among whites (37% compared with 18%, p less than 0.001). Blacks were more likely than whites to have had their last test for screening purposes (97% compared with 78%, p less than 0.01). Approximately half of the women who had had this procedure had had it within the past year.

A digital rectal examination to detect colorectal cancer early is a recommended component of periodic health examinations for all persons aged 40 and over. Blacks were less likely than whites to know about this test (72% compared with 81%, p less than 0.001). About half (55%-61%) of persons in each race-sex group reported having had at least one digital rectal examination; however, nearly a quarter of these examinations were performed because the patient was having health problems.

Data for blood stool examination and proctoscopy are given in Table 1 for persons aged 40 and over. For colorectal cancer screening in the group aged 50 and over, a blood stool examination once a year and a proctoscopic examination every 3 to 5 years are recommended. These tests are seldom performed. One major reason cited is lack of knowledge among the public. In the group aged 40 and over, 25% of blacks, compared with 15% of whites (p less than 0.001), had no knowledge of blood stool examinations; only 39% of those interviewed had ever had one. Similarly, more than half the blacks (55%) and nearly a third of the whites (29%) had never heard of proctoscopy (p less than 0.001). Only 25% of the adults interviewed had ever had a proctoscopic examination. Reported by: Surveillance and Operations Research Br, National Cancer Institute, National Institutes of Health. Div of Health Interview Statistics, National Center for Health Statistics; Div of Chronic Disease Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: NHIS is a continuous, cross-sectional, nationwide survey conducted through household interviews (3). To obtain information on health and other characteristics of each household member in the civilian noninstitutionalized population, personnel from the U.S. Department of Commerce, Bureau of the Census, interview a probability sample of households each week.

Estimates presented here are provisional; final estimates will be made in late 1988. The provisional estimates are based on a sample of the civilian noninstitutionalized population and, therefore, are subject to sampling error. In addition, for some items shown in Table 1, the estimate is small for a given characteristic. When the numerator or denominator of a rate is small, the sampling error may be relatively high. For purposes of statistical reliability, data are not included if the denominator is less than 100 or the cell size is less than 29.

With the exception of the Pap smear and physical breast examination, cancer screening procedures are underutilized in the United States. This is apparent even though screening tests for some cancers (e.g., breast) have increased markedly in recent years (4; CDC, unpublished data). Screening procedures are underutilized for various reasons, but one factor is that many people have never heard of mammography or of digital rectal, blood stool, and proctoscopic examinations (Table 1). The finding that blacks are less likely than whites to know about screening procedures for cancer supports the findings of other recent studies (5). The data reported here show that racial differences exist in knowledge about, and use of, all screening procedures except the Pap smear. Forthcoming reports from the NHIS will examine demographic characteristics and accessibility of medical care in relation to cancer screening tests. Efforts to increase the use of these screening tests must include educating the public concerning their routine use of the tests according to recommended guidelines. This practice permits the early detection of disease when treatment is most effective, that is, before symptoms occur.

References

1. National Cancer Institute. Cancer control objectives for the nation: 1985-2000. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1986; DHHS publication no. (NIH)86-2880. (NCI monograph no. 2).

2. National Cancer Institute. Working guidelines for early cancer detection: rationale and supporting evidence to decrease mortality. Washington, DC: US Department of Health and Human Services, Public Health Service, 1987.

3. National Center for Health Statistics. Programs and collection procedures: the National Health Interview Survey Design 1973-1984 and procedures 1975-1983. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service; DHHS publication no. (PHS)85-1320. (Series 1, no. 18).

4. Chow W-H, Liff JM, Greenberg RS. Mammography in Atlanta. J Med Assoc Ga 1987; 76:788-92.

5. Bang KM, White JE, Gause BL, Leffall LD Jr. Evaluation of recent trends in cancer mortality and incidence among blacks. Cancer 1988;61:1255-61.

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