Yoshida Y, Schmaltz C L, Jackson-Thompson J, Simoes E J
Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, Columbia, MO, USA; Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, MO, USA.
Department of Health Management and Informatics, School of Medicine, University of Missouri-Columbia, Columbia, MO, USA; Missouri Cancer Registry and Research Center, University of Missouri-Columbia, Columbia, MO, USA.
Public Health. 2018 Jan;154:51-58. doi: 10.1016/j.puhe.2017.10.015. Epub 2017 Dec 1.
Population-based evidence regarding impact of cancer screenings and cancer rates in Missouri is lacking. This study examined whether screenings of breast cancer, cervical cancer, and colorectal cancer impact early-stage cancer incidence and mortality in Missouri.
This is an ecological study based on county-specific estimates of selected cancer screening prevalence and early-stage cancer incidence and cancer mortality.
County-specific prevalence of clinical breast examination, mammography, Pap test, sigmoidoscopy or colonoscopy, and fecal occult blood test (FOBT) were generated from Missouri County-Level Study (2003, 2007, and 2011). County-specific crude incidence and mortality were calculated (2004-2013). Pearson's correlation and Poisson regression were used to test association between cancer rate and screening prevalence. Covariates included county-level mean age, percentage of whites, percentage with low income, percentage with less than high school education high school, percentage with no insurance, and percentage having difficulties accessing care.
In the adjusted model, 'ever had Pap test' was significantly associated with an increase of 8% in early-stage cervical cancer incidence. Having clinical breast examination or Pap test in the past was also associated with decreases in mortality by 3% and 4%, respectively, although the association was not significant for Pap test. In addition, having mammography was statistically significantly associated with early-stage breast cancer incidence, and having FOBT or sigmoidoscopy or colonoscopy was associated with decreased colorectal cancer mortality; however, magnitude for these associations was only around 1%.
This study provides ecological evidence of the effectiveness of screening services in predicting early stage cancer incidence and in reducing mortality across Missouri counties. Further incentive to promote these screenings in Missouri is needed.
缺乏关于密苏里州癌症筛查影响及癌症发病率的基于人群的证据。本研究调查了乳腺癌、宫颈癌和结直肠癌筛查是否会影响密苏里州早期癌症的发病率和死亡率。
这是一项基于特定县的选定癌症筛查患病率、早期癌症发病率和癌症死亡率估计值的生态学研究。
临床乳房检查、乳房X光检查、巴氏试验、乙状结肠镜检查或结肠镜检查以及粪便潜血试验（FOBT）的特定县患病率来自密苏里州县级研究（2003年、2007年和2011年）。计算特定县的粗发病率和死亡率（2004 - 2013年）。使用Pearson相关性和泊松回归来检验癌症发病率与筛查患病率之间的关联。协变量包括县级平均年龄、白人百分比、低收入百分比、高中以下学历百分比、无保险百分比以及就医困难百分比。
在调整模型中，“曾进行巴氏试验”与早期宫颈癌发病率增加8%显著相关。过去进行临床乳房检查或巴氏试验也分别与死亡率降低3%和4%相关，尽管巴氏试验的关联不显著。此外，进行乳房X光检查与早期乳腺癌发病率在统计学上显著相关，进行FOBT或乙状结肠镜检查或结肠镜检查与结直肠癌死亡率降低相关；然而，这些关联的幅度仅约为1%。
本研究提供了生态学证据，证明筛查服务在预测密苏里州各县早期癌症发病率和降低死亡率方面的有效性。需要进一步激励在密苏里州推广这些筛查。
