Breen N, Wagener D K, Brown M L, Davis W W, Ballard-Barbash R
Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892-7344, USA.
J Natl Cancer Inst. 2001 Nov 21;93(22):1704-13. doi: 10.1093/jnci/93.22.1704.
Screening to detect cancer early, an increasingly important cancer control activity, cannot be effective unless it is widely used.
Use of Pap smears, mammography, fecal occult blood tests (FOBTs), sigmoidoscopy, and digital rectal examination (DRE) was evaluated in the 1987, 1992, and 1998 National Health Interview Surveys. Levels and trends in screening use were examined by sex, age, and racial/ethnic group. The effects of income, educational level, and health care coverage were examined within age groups. Logistic regression analyses of 1998 data were used to develop a parsimonious, policy-relevant model.
Use of all screening modalities increased over the period examined; for mammography and DRE, the increase was more rapid in the first half of the decade; for the Pap test and sigmoidoscopy, the increase was more rapid in the second half of the decade. Levels of colorectal cancer screening (both sigmoidoscopy and FOBTs) in 1998 were less than the level that prevailed a decade earlier for mammography. Patterns of change for all screening modalities differed between age, sex, and racial/ethnic groups, but prevalence of use during the study, within recommended time intervals, was consistently lower among groups with lower income and less education. Logistic regression analyses indicated that insurance coverage and, to a greater extent, usual source of care had strong independent associations with screening usage when age, sex, racial/ethnic group, and educational level were taken into account.
While cancer screening is generally increasing in the United States, usage is relatively low for colorectal cancer screening and among groups that lack health insurance or a usual source of care.
筛查以早期发现癌症，这一癌症控制活动愈发重要，除非广泛应用，否则无法有效。
在1987年、1992年和1998年的国民健康访谈调查中评估了巴氏涂片检查、乳房X线摄影、粪便潜血试验（FOBT）、乙状结肠镜检查和直肠指检（DRE）的使用情况。按性别、年龄和种族/族裔群体检查了筛查使用的水平和趋势。在年龄组内研究了收入、教育水平和医保覆盖范围的影响。使用1998年数据进行逻辑回归分析以建立一个简洁且与政策相关的模型。
在所研究期间，所有筛查方式的使用均有所增加；对于乳房X线摄影和直肠指检，在该十年的前半期增长更为迅速；对于巴氏试验和乙状结肠镜检查，在该十年的后半期增长更为迅速。1998年结直肠癌筛查（乙状结肠镜检查和粪便潜血试验）的水平低于十年前乳房X线摄影的水平。所有筛查方式的变化模式在年龄、性别和种族/族裔群体之间存在差异，但在推荐时间间隔内，研究期间使用率在收入较低和教育程度较低的群体中始终较低。逻辑回归分析表明，在考虑年龄、性别、种族/族裔群体和教育水平时，医保覆盖范围以及在更大程度上的常规医疗来源与筛查使用有很强的独立关联。
虽然美国的癌症筛查总体上在增加，但结直肠癌筛查的使用率相对较低，在缺乏医保或常规医疗来源的群体中也是如此。
