Ruffin M T, Gorenflo D W, Woodman B
Department of Family Medicine, University of Michigan Health System, Ann Arbor 48109-0708, USA.
J Am Board Fam Pract. 2000 Jan-Feb;13(1):1-10. doi: 10.3122/jabfm.13.1.1.
As we enter the year 2000, it is worth looking at whether primary care practices are reaching the goals established in Healthy People 2000 for breast, cervical, colorectal, and prostatic cancer screening. The objectives of this study were (1) to determine the current rates of cancer screening; and (2) to determine which factors predict completion of a single screening test, of all tests for each cancer, and of all procedures for age and sex.
Medical records of 200 eligible patients (100 men and 100 women) from each of 24 community-based primary care practices were abstracted for cancer-screening events.
We audited 5125 charts. A Papanicolaou smear was documented for 63.8% of women with an intact cervix within 3 years of the audit.. We found that 46.8% of women had documentation of ever having a discussion of breast self-examination. For breast cancer screening, 41.8% of the women had a clinical breast examination within 1 year, 48.2% aged 40 to 49 years had a mammogram within 2 years, and 38.5% aged 50 years and older had a mammogram within 1 year. Only 29% of women aged 40 to 49 years and 17% of women 50 years and older were current for all breast cancer-screening tests. Among patients 50 years and older, 33% of men and 38% of women had a digital rectal examination within 1 year, 26% of men and 28% of women had a fecal occult blood test within 1 year, and 22% of men and 16.8% of women had a flexible sigmoidoscopy within 5 years. Of all men 28.7% had a prostate-specific antigen test within 1 year. Completion of all tests relevant for age and sex were documented for 8.6% of women aged 40 to 49 years, 3% of women 50 years and older, and 5% of men 50 years and older. The single most significant predictor of documented cancer screening was a health maintenance visit.
This sample of primary care clinicians has not reached the goals set in Healthy People 2000 for cancer screening. Interventions aimed at increasing the percentage of patients who schedule a health maintenance visit could serve to increase cancer screening and help us reach goals set for the year 2010.
在我们进入2000年之际，值得审视基层医疗服务机构是否实现了《健康人民2000》中设定的乳腺癌、宫颈癌、结直肠癌和前列腺癌筛查目标。本研究的目的是：（1）确定当前的癌症筛查率；（2）确定哪些因素可预测单项筛查测试、每种癌症的所有测试以及按年龄和性别划分的所有检查程序的完成情况。
从24家社区基层医疗服务机构中，每家抽取200名符合条件的患者（100名男性和100名女性）的病历，提取癌症筛查相关事件。
我们审核了5125份病历。在审核的3年内，63.8%宫颈完整的女性有巴氏涂片检查记录。我们发现，46.8%的女性有过关于乳房自我检查讨论的记录。对于乳腺癌筛查，41.8%的女性在1年内接受了临床乳房检查，48.2%年龄在40至49岁的女性在2年内进行了乳房X光检查，38.5%年龄在50岁及以上的女性在1年内进行了乳房X光检查。在年龄40至49岁的女性中，只有29%、50岁及以上的女性中只有17%完成了所有乳腺癌筛查测试。在50岁及以上的患者中，33%的男性和38%的女性在1年内接受了直肠指检，26%的男性和28%的女性在1年内接受了粪便潜血试验，22%的男性和16.8%的女性在5年内接受了乙状结肠镜检查。在所有男性中，28.7%在1年内进行了前列腺特异性抗原检测。年龄在40至49岁的女性中，8.6%、50岁及以上的女性中3%以及50岁及以上的男性中5%完成了与年龄和性别相关的所有检查。记录在案的癌症筛查的最显著预测因素是健康维护就诊。
这个基层医疗临床医生样本未达到《健康人民2000》中设定的癌症筛查目标。旨在提高安排健康维护就诊患者比例的干预措施，可能有助于增加癌症筛查，并帮助我们实现2010年设定的目标。
