Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas.
Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2019 May 3;2(5):e193759. doi: 10.1001/jamanetworkopen.2019.3759.
National guidelines recommend screening for several cancer types, yet screening rates remain below target. To date, cancer screening patterns by smoking status, a major cancer risk factor, are unknown.
To assess cancer screening patterns among individuals who never smoked (never smokers), formerly smoked (former smokers), and currently smoke (current smokers) in the United States.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study assessed data from the National Health Interview Survey years 2010, 2013, and 2015. Adult participants (aged ≥18 years) who had never reported a cancer diagnosis were included in the analysis. Data were analyzed from August 1, 2018, through February 1, 2019.
Receipt of cancer screening, including colonoscopy, mammography, prostate-specific antigen testing, and Papanicolaou test per the US Preventive Services Task Force guidelines.
Multivariable logistic regression defined adjusted odds ratios (AORs) and 95% CIs for undergoing cancer screening by smoking status. Among participants who received a specific screening test, AORs and 95% CIs of receiving the test within guideline-recommended intervals were also assessed.
Among 83 176 participants (45 851 [55.1%] women; mean [SD] age, 47 [18] years), 51 014 (61.3%) were never smokers; 17 235 (20.7%), former smokers; and 14 927 (17.9%), current smokers. Compared with never smokers, current smokers were less likely to ever have received a colonoscopy (43.8% vs 57.7%; AOR, 0.74; 95% CI, 0.68-0.82; P < .001), mammogram (88.8% vs 93.3%; AOR, 0.70; 95% CI, 0.57-0.87; P = .001), or prostate-specific antigen test (46.1% vs 60.8%; AOR, 0.76; 95% CI, 0.64-0.90; P = .001). Among those who had ever received a specific screening test, current smokers were less likely to have undergone colonoscopy (92.1% vs 95.1%; AOR, 0.75; 95% CI, 0.59-0.96; P = .02), mammography (62.4% vs 79.4%; AOR, 0.52; 95% CI, 0.45-0.60; P < .001), or Papanicolaou test (80.9% vs 90.8%; AOR, 0.61; 95% CI, 0.56-0.67; P < .001) within the recommended time frame compared with never smokers. Former smokers were more likely than never smokers to undergo any of the screening studies evaluated, with the exception of prostate-specific antigen screening (colonoscopy, 65.2% vs 57.7%; AOR, 1.20; 95% CI, 1.12-1.30; P < .001; mammography, 95.7% vs 93.3%; AOR, 1.35; 95% CI, 1.07-1.70; P = .01; Papanicolaou test, 97.6% vs 91.4%; AOR, 2.51; 95% CI, 1.93-3.26; P < .001).
This study found that current smokers appeared to be less likely to receive guideline-concordant screening studies for breast, prostate, and colorectal cancer compared with never smokers. Further research is needed to identify barriers to screening among current smokers with the goal of increasing acceptance and uptake of cancer screening among this population at high risk of cancer.
国家指南建议对多种癌症类型进行筛查，但筛查率仍低于目标。迄今为止，尚不清楚与主要癌症风险因素——吸烟状况相关的癌症筛查模式。
评估美国从不吸烟者（从不吸烟者）、曾经吸烟者（曾经吸烟者）和当前吸烟者（当前吸烟者）的癌症筛查模式。
设计、地点和参与者：本横断面研究分析了 2010 年、2013 年和 2015 年全国健康访谈调查的数据。分析纳入了从未报告过癌症诊断的成年参与者（年龄≥18 岁）。研究数据于 2018 年 8 月 1 日至 2019 年 2 月 1 日进行分析。
根据美国预防服务工作组指南，接受癌症筛查，包括结肠镜检查、乳房 X 线摄影术、前列腺特异性抗原检测和巴氏试验。
多变量逻辑回归定义了按吸烟状况进行癌症筛查的调整优势比（AOR）和 95%置信区间（CI）。在接受特定筛查测试的参与者中，还评估了在指南推荐的时间间隔内接受测试的 AOR 和 95%CI。
在 83176 名参与者中（45851[55.1%]名女性；平均[标准差]年龄，47[18]岁），51014 名（61.3%）为从不吸烟者；17235 名（20.7%）为曾经吸烟者；14927 名（17.9%）为当前吸烟者。与从不吸烟者相比，当前吸烟者更不可能接受过结肠镜检查（43.8%比 57.7%；AOR，0.74；95%CI，0.68-0.82；P<0.001）、乳房 X 线摄影术（88.8%比 93.3%；AOR，0.70；95%CI，0.57-0.87；P=0.001）或前列腺特异性抗原检测（46.1%比 60.8%；AOR，0.76；95%CI，0.64-0.90；P=0.001）。在那些曾经接受过特定筛查测试的人中，当前吸烟者更不可能在推荐的时间范围内接受结肠镜检查（92.1%比 95.1%；AOR，0.75；95%CI，0.59-0.96；P=0.02）、乳房 X 线摄影术（62.4%比 79.4%；AOR，0.52；95%CI，0.45-0.60；P<0.001）或巴氏试验（80.9%比 90.8%；AOR，0.61；95%CI，0.56-0.67；P<0.001），与从不吸烟者相比。与从不吸烟者相比，曾经吸烟者更有可能接受所有评估的筛查研究，除了前列腺特异性抗原筛查（结肠镜检查，65.2%比 57.7%；AOR，1.20；95%CI，1.12-1.30；P<0.001；乳房 X 线摄影术，95.7%比 93.3%；AOR，1.35；95%CI，1.07-1.70；P=0.01；巴氏试验，97.6%比 91.4%；AOR，2.51；95%CI，1.93-3.26；P<0.001）。
本研究发现，与从不吸烟者相比，当前吸烟者接受乳腺癌、前列腺癌和结直肠癌指南一致筛查研究的可能性似乎较低。需要进一步研究以确定当前吸烟者在筛查方面的障碍，以期提高这一癌症高危人群对癌症筛查的接受度和参与度。
Zotero 插件