Figures and data in US women screen at low rates for both cervical and colorectal cancers than a single cancer: a cross-sectional population-based observational study

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Tables
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2 figures, 5 tables and 2 additional files

Figures

Figure 1

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Graphical abstract.

Screening rates differ by calculation approach. A patient-centered approach considers the total number of screens each woman has, whereas a population-centered system documents each single test completion. Our data show much lower women-centered cervical cancer and colorectal cancer (CRC) screening rates than a population-based screening approach. This difference is especially relevant as women may be able to do these two cancer screenings at home by themselves.

Appendix 1—figure 1

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Tables

Table 1

Demographic characteristics of the study population.

	Weighted %	Eligible for analysis (n = 40,511)
Age, n (%)
50–54	35.8	12,165 (30.0)
55–59	31.3	13,757 (34.0)
60–64	32.9	14,589 (36.0)
Race, n (%)
NH White	67.4	31,340 (77.4)
NH Black	10.6	3401 (98.4)
NH Other/Multiracial	6.9	2484 (6.1)
Hispanic	13.5	2836 (7.0)
Unknown/Refused	1.5	450 (1.1)
Marital, n (%)
Married/partnered	63.4	25,022 (61.8)
Unmarried*	35.9	15,335 (37.9)
Unknown/refused	0.7	154 (0.4)
Education, n (%)
Less than high school	11.6	2293 (5.7)
High school	25.1	9447 (23.3)
Attended college/Tech school	31.1	11,066 (27.3)
Graduated college/Tech school	32.1	17,671 (43.6)
Refused/don’t know	0.2	34 (0.1)
Location, n (%)
Urban	92.7	33,500 (82.7)
Rural	6.2	6292 (15.5)
Unknown/missing	1.1	719 (1.8)
Income, n (%)
<50,000	36.5	14,870 (36.7)
50,000+	46.4	20,295 (50.1)
Don’t know/refused	17.1	5346 (13.2)
Employment status^†, n (%)
Employed/self-employed	59.5	25,289 (62.4)
Unemployed, looking	5.4	1866 (4.6)
Unemployed, not looking	21.3	8392 (20.7)
Unable to work	12.7	4763 (11.8)
Refused	1.2	201 (0.5)

*

Unmarried includes divorced, widowed, separated, and never married.
†

‘Unemployed, not looking’ includes ‘Homemaker, Student, and Retired’, ‘Unemployed, looking’ includes out of work over a year and out of work less than a year.

Table 2

Up-to-date screening status by woman by screening modality.

	Dual screened, n = 24,678; 58.2% (57.1, 59.4)			Current for colorectal only, n = 22225.4% (4.9, 5.9)
	Pap only, within last 3 years	HPV only, within last 5 years	Pap and HPV, within last 5 years	Current for colorectal only, n = 22225.4% (4.9, 5.9)
Blood stool only, last year	5.0 (4.3, 5.8)	0.1 (0.001, 0.2)	3.0 (2.5, 3.6)	10.0 (7.7, 13.1)
Sigmoidoscopy only, last 5 years	0.6 (0.4, 0.8)	<0.1%	0.4 (0.3, 0.5)	1.2 (0.6, 2.3)
Colonoscopy only, last 10 years	54.6 (53.2, 55.9)	1.9 (1.4, 2.5)	27.2 (26.0, 28.3)	83.3 (79.4, 86.6)
Two CRC tests	3.8 (3.4, 4.3)	<0.1%	3.3 (2.8, 4.0)	5.5 (3.4, 8.6)
Current for cervical cancer only, n = 10,051 27.1% (26.0, 28.2)	66.5 (64.2, 68.6)	2.9 (2.2, 3.7)	30.7 (28.6, 32.8)	100%
Not current for either, n = 3560; 9.3% (8.7, 9.9)

Women receiving only one of the two screens
CRC: The left-hand column lists the types of colorectal cancer screening that a woman could report. The far right-hand column presents the weighted screening proportions (95% CI) of women with only CRC screening by that modality. For instance, 10.0% of the 5.4% of women who were only current for CRC indicated they had been screened with a blood stool test within the last year but had no other CRC screen and no other cervical cancer screen. Likewise, 83.3% of the 5.4% of women who were only current on CRC screening (but had no other CRC screen and no other cervical cancer screen) indicated that they had a colonoscopy within the past 10 years.
Cervical: The second to bottom row indicates the weighted screening proportions (95% CI) of women who only were up- to -date with cervical cancer screening by the columnar headings for types of cervical cancer screening modalities. For instance, 66.5% of the 27.1% of women who only had cervical cancer screening received a Pap test within the past 3 years. Likewise, 30.7% of the 27.1% of women who only had cervical cancer screening had received co-testing within the past 5 years.
Women who had both screens by modality
The top row indicates that 58.2% of all women were up-to-date with both cervical cancer and colorectal cancer screening (dual-screening). The inner 12 cells indicate the weighted percentage of women with dual-screening by modality. For instance, 54.6% of the 58.2% of women having both screens up-to-date did so with a colonoscopy and a Pap test. Likewise, 27.4% of 58.7% of women having both screens up-to-date did so with colonoscopy and cotesting.
Women not up-to-date with either screen
The bottom row indicates that 9.3% of the analytic cohort received neither screen because of underscreening or no screening.
CI, confidence interval; CRC, colorectal cancer.

Table 3

Sociodemographic descriptors by screening category.

Total	Dual-screening			Cervical cancer screening alone			CRC screening alone			Neither screening
n = 40,511	N = 24,678			N = 10,051			N = 2222			N = 3560
	N	Unweighted row %	Weighted row %	N	Unweighted row %	Weighted row %	N	Unweighted row %	Weighted row %	N	Unweighted row %	Weighted row %
Age, (n, row %)
50–54	6121	50.3	47.4	4603	37.8	40.0	355	2.9	3.1	1086	8.9	9.5
55–59	8864	64.4	62.5	2893	21.0	22.7	778	5.7	5.2	1222	8.9	9.6
60–64	9693	66.4	66.0	2555	17.5	17.3	1089	7.5	7.9	1252	8.6	8.8
Race (n, row %)
White	19,507	62.2	60.3	7345	23.4	24.8	1799	5.7	5.6	2689	8.6	9.3
Black	2198	64.6	60.7	856	25.2	26.6	137	4.0	5.4	210	6.2	7.4
Other*	1335	53.7	59.2	706	28.4	25.2	135	5.4	3.0	308	12.4	12.6
Hispanic	1381	48.7	46.5	1025	36.1	39.4	126	4.4	5.2	304	10.7	8.8
Education (n, row %)
Less than high school graduate	965	42.1	41.0	775	33.8	36.8	152	6.6	6.9	401	17.5	15.3
High school graduate	5109	54.1	52.9	2574	27.3	27.7	583	6.2	6.5	1181	12.5	12.8
Attended college/Tech school	6587	59.5	60.0	2820	25.5	26.2	679	6.1	5.4	989	8.9	8.4
Graduated college/Tech school	11,994	67.9	67.0	3876	21.9	24.2	816	4.6	3.8	985	5.6	5.1
Income (n, row %)
<$50K	7779	52.3	49.7	4127	27.8	29.8	1021	6.9	6.7	1943	13.1	13.8
≥$50K	13,711	67.6	65.7	4562	22.5	24.5	930	4.6	4.3	1092	5.4	5.5
Marital status (n, row %)
Married or partnered	15,966	63.8	61.0	6014	24.0	26.3	1230	4.9	5.0	1812	7.2	7.7
Single^*	8630	56.3	53.7	3995	26.1	28.2	979	6.4	6.0	1731	11.3	12.1
Occupational status (n, row %)
Employed	15,613	61.7	58.6	6566	26.0	28.6	1126	4.5	4.4	1984	7.9	8.4
Unemployed, looking^†	975	52.3	52.3	533	28.6	28.8	111	60	5.6	247	13.2	13.4
Unemployed, not looking^†	5327	63.5	62.5	1758	21.0	23.3	543	6.5	5.8	764	9.1	9.0
Unable to work	2662	55.9	53.5	1132	23.8	25.6	435	9.1	9.2	534	11.2	11.7
Location (n, row %)
Urban	20,903	62.4	58.9	8105	24.2	26.8	1762	5.3	5.3	2730	8.2	9.0
Rural	3479	55.3	52.0	1662	26.4	28.4	431	6.9	7.2	720	11.4	12.4
Chronic conditions (n, row %)
ANY	16,168	63.2	60.7	5724	22.4	24.5	1631	6.4	6.4	2052	8.0	8.4
Cardiac	1117	56.5	55.1	457	23.1	23.5	176	8.9	8.4	228	11.5	13.1
Stroke	745	58.6	60.6	293	23.1	24.2	101	8.0	5.2	132	10.4	9.9
Lung	4039	60.2	58.5	1539	22.9	25.6	479	7.1	6.3	655	9.8	9.6
Arthritis	9799	64.3	62.9	3237	21.3	22.3	1049	6.9	7.2	1148	7.5	7.6
Kidney	751	62.3	63.2	242	20.1	19.5	96	8.0	5.2	117	9.7	12.1
Diabetes	2988	58.6	54.8	1233	24.2	28.9	413	8.1	7.6	468	9.2	8.7
Depression	5987	62.2	60.2	2133	22.2	24.5	695	7.2	6.7	805	8.4	8.5
Skin cancer	2182	70.4	68.4	540	17.4	18.7	189	6.1	5.1	190	6.1	7.8
Other cancer	2282	69.3	67.2	648	19.7	22.8	209	6.3	6.3	156	4.7	3.7

CRC, colorectal cancer.
*

Single includes divorced, widowed, separated, and never married.
†

‘Unemployed, not looking’ includes ‘Homemaker, Student, and Retired’, ‘Unemployed, looking’ includes out of work over a year and out of work less than a year.

Table 4

Multinomial multivariate regression.

N = 42,701Weighted n = 19,849,774	Referent outcome: neither screen			Referent outcome: dual screens		Referent outcome:cervical only
	Dual screen	Cervical only	CRC only	Cervical only	CRC only	CRC only
	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)	aOR (95% CI)
Age
50–54	Ref	Ref	Ref	Ref	Ref	Ref
55–59	*1.35 (1.09, 1.67)*	*0.60 (0.48, 0.76)*	*1.76 (1.25, 2.47)*	*0.44 (0.39, 0.51)*	1.30 (0.98, 1.74)	*2.93 (2.17, 3.96)*
60–64	*1.46 (1.18, 1.79)*	*0.45 (0.36, 0.56)*	*2.55 (1.81, 3.58)*	*0.31 (0.27, 0.36)*	*1.75 (1.30, 2.35)*	*5.63 (4.14, 7.66)*
Race
White	Ref	Ref	Ref	Ref	Ref	Ref
Black	*2.25 (1.62, 3.13)*	*1.73 (1.22, 2.44)*	1.58 (0.95, 2.61)	*0.77 (0.64, 0.92)*	0.70 (0.46, 1.07)	0.91 (0.59, 1.41)
Other*	0.72 (0.46, 1.12)	0.76 (0.47, 1.21)	*0.37 (0.21, 0.64)*	1.05 (0.74, 1.50)	*0.51 (0.33, 0.80)*	*0.49 (0.30, 0.80)*
Hispanic	*1.68 (1.25, 2.25)*	*2.34 (1.72, 3.18)*	1.42 (0.77, 2.63)	*1.39 (1.10, 1.77)*	0.84 (0.48, 1.50)	0.61 (0.34, 1.10)
Education
Less than high school	Ref	Ref	Ref	Ref	Ref	Ref
High school graduate	*1.37 (1.02, 1.83)*	1.08 (0.80, 1.46)	1.14 (0.65, 1.98)	0.78 (0.61, 1.01)	0.83 (0.49, 1.39)	1.06 (0.62, 1.80)
Attended college/Tech school	*1.98 (1.46, 2.69)*	*1.47 (1.07, 2.00)*	1.30 (0.76, 2.22)	*0.74 (0.58, 0.95)*	0.65 (0.40, 1.07)	0.88 (0.53, 1.46)
Graduated college/Tech school	*3.35 (2.33, 4.81)*	*2.02 (1.39, 2.94)*	1.66 (0.94, 2.93)	*0.60 (0.46, 0.79)*	*0.50 (0.31, 0.81)*	0.82 (0.49, 1.36)
Income
<$50K	Ref	Ref	Ref	Ref	Ref	Ref
≥$50K	*3.32 (2.64, 4.18)*	*2.19 (1.71, 2.80)*	*2.13 (1.54, 2.96)*	*0.66 (0.58, 0.75)*	*0.64 (0.49, 0.84)*	0.98 (0.74, 1.29)
Chronic conditions^†
Arthritis	*1.83 (1.54, 2.18)*	*1.28 (1.06, 1.55)*	*2.17 (1.65, 2.87)*	*0.70 (0.61, 0.80)*	1.19 (0.94, 1.50)	*1.70 (1.31, 2.19)*
Diabetes	*1.34 (1.06, 1.69)*	*1.34 (1.03, 1.75)*	*1.79 (1.25, 2.55)*	1.00 (0.83, 1.22)	1.33 (0.98, 1.81)	1.33 (0.95, 1.86)
Depression	*1.35 (1.11, 1.63)*	1.05 (0.85, 1.29)	*1.47 (1.09, 1.99)*	*0.78 (0.68, 0.89)*	1.09 (0.85, 1.41)	*1.41 (1.07, 1.84)*
Skin cancer	1.04 (0.73, 1.48)	0.78 (0.53, 1.15)	0.75 (0.48, 1.17)	*0.75 (0.61, 0.92)*	*0.72 (0.54, 0.97)*	0.97 (0.69, 1.36)
Other cancer	*2.90 (2.09, 4.05)*	*2.28 (1.57, 3.31)*	*3.08 (1.94, 4.91)*	*0.78 (0.62, 0.99)*	1.06 (0.75, 1.51)	1.35 (0.90, 2.03)

aOR, adjusted odds ratio; CI, confidence interval; CRC, colorectal cancer. Bold values = statistically significant.
*

Other means American Indian, Native Hawaiian, Asian, Multiracial, and 'Other'.
†

Persons may have more than one condition or cancer.

Appendix 1—table 1

Unadjusted multinomial regression.

	Referent outcome: neither screen			Referent outcome: dual screens		Referent outcome:cervical only
	Dual screens	Cervical only	CRC only	Cervical only	CRC only	CRC only
	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)	OR (95% CI)
Age
50–54	Ref	Ref	Ref	Ref	Ref	Ref
55–59	*1.29 (1.07, 1.56)*	*0.55 (0.45,0.68)*	*1.68 (1.24, 2.29)*	*0.43 (0.37, 0.49)*	*1.30 (1.01, 1.69)*	*3.05 (2.31, 4.01)*
60–64	*1.48 (1.24, 1.78)*	*0.45 (0.37, 0.56)*	*2.74 (2.04, 3.70)*	*0.31 (0.27, 0.35)*	*1.85 (1.44, 2.39)*	*6.04 (4.60, 7.93)*
Race
White	Ref	Ref	Ref	Ref	Ref	Ref
Black	*1.28 (0.98, 1.67)*	*1.33 (1.01, 1.76)*	1.20 (0.77, 1.86)	1.04 (0.88, 1.22)	0.93 (0.64, 1.36)	0.90 (0.61, 1.33)
Other*	0.73 (0.49, 1.09)	0.76 (0.49, 1.17)	*0.35 (0.21, 0.60)*	1.04 (0.77, 1.40)	*0.49 (0.32,0.74)*	*0.47 (0.29, 0.74)*
Hispanic	0.80 (0.64, 1.00)	*1.63 (1.25, 2.12)*	0.96 (0.62, 1.51)	*2.04 (1.67, 2.50)*	1.21 (0.80,1.83)	*0.59 (0.38, 0.91)*
Education
Less than high school	Ref	Ref	Ref	Ref	Ref	Ref
High school graduate	*1.54 (1.20, 1.98)*	0.90 (0.67, 1.21)	1.14 (0.76, 1.72)	*0.58 (0.46, 0.75)*	0.74 (0.51, 1.08)	1.27 (0.84, 1.91)
Attended college/Tech school	*2.62 (2.03, 3.37)*	1.29 (0.96, 1.74)	1.42 (0.96, 2.11)	*0.49 (0.39, 0.63)*	*0.54 (0.38, 0.78)*	1.10 (0.75, 1.62)
Graduated college/Tech school	*4.84 (3.67, 6.38)*	*1.96 (1.43, 2.69)*	*1.64 (1.09, 2.45)*	*0.41 (0.32, 0.52)*	*0.34 (0.24, 0.48)*	0.83 (0.57, 1.22)
Income
<$50K	Ref	Ref	Ref	Ref	Ref	Ref
>$50K	*3.30 (2.79, 3.90)*	*2.07 (1.72, 2.48)*	*1.60 (1.24, 2.07)*	*0.63 (0.56, 0.70)*	*0.49 (0.39, 0.60)*	*0.78 (0.62, 0.97)*
Marital status
Married or partnered	Ref	Ref	Ref	Ref	Ref	Ref
Single^†	*0.56 (0.48, 0.66)*	*0.68 (0.57,0.81)*	*0.78 (0.61, 0.99)*	*1.21 (1.08, 1.35)*	*1.38 (1.13,1.69)*	1.14 (0.92, 1.42)
Occupational status
Employed	Ref	Ref	Ref	Ref	Ref	Ref
Unemployed, looking^‡	*0.56 (0.41, 0.78)*	*0.64 (0.46, 0.88)*	0.81 (0.51, 1.28)	1.12 (0.87, 1.45)	1.43 (0.95, 2.17)	1.27 (0.83, 1.94)
Unemployed, not looking^‡	0.99 (0.83, 1.19)	*0.76 (0.60, 0.96)*	1.22 (0.92, 1.63)	*0.76 (0.64, 0.91)*	1.23 (0.97, 1.57)	*1.61 (1.22, 2.13)*
Unable to work	*0.64 (0.52,0.79)*	*0.64 (0.50, 0.81)*	*1.52 (1.10, 2.10)*	0.99 (0.84, 1.16)	*2.36 (1.81, 3.08)*	*2.39 (1.78, 3.20)*
Location
Urban	Ref	Ref	Ref	Ref	Ref	Ref
Rural	*0.64 (0.52, 0.78)*	*0.76 (0.61, 0.95)*	0.97 (0.72, 1.30)	*1.20 (1.04, 1.39)*	*1.52 (1.20, 1.94)*	1.27 (0.98, 1.65)
Chronic conditions ^§
Cardiac	*0.64 (0.48, 0.87)*	*0.59 (0.42,0.83)*	1.11 (0.74, 1.65)	0.92 (0.74, 1.14)	*1.72 (1.26, 2.35)*	*1.87 (1.33, 2.64)*
Stroke	0.96 (0.64, 1.42)	0.80 (0.52, 1.23)	0.90 (0.54, 1.51)	0.84 (0.64, 1.10)	0.94 (0.63, 1.39)	1.12 (0.73, 1.72)
Lung	0.95 (0.80, 1.14)	0.89 (0.70, 1.13)	1.15 (0.87, 1.53)	0.93 (0.77, 1.12)	1.21 (0.95, 1.54)	1.30 (0.97, 1.74)
Arthritis	*1.51 (1.30, 1.76)*	0.99 (0.83, 1.18)	*2.27 (1.80, 2.86)*	*0.65 (0.58, 0.74)*	*1.50 (1.24, 1.81)*	*2.29 (1.85, 2.82)*
Kidney	0.84 (0.57, 1.23)	*0.56 (0.36, 0.87)*	0.76 (0.44, 1.30)	*0.66 (0.49, 0.91)*	0.90 (0.59, 1.39)	1.36 (0.83, 2.23)
Diabetes	1.04 (0.83, 1.29)	*1.18 (0.89, 1.58)*	*1.72 (1.24, 2.38)*	*1.66 (1.27, 2.15)*	*1.66 (1.27, 2.15)*	*1.46 (1.05, 2.01)*
Depression	1.16 (0.99, 1.37)	0.97 (0.79, 1.20)	*1.56 (1.21, 2.01)*	*0.84 (0.72, 0.98)*	*1.34 (1.08, 1.65)*	*1.60 (1.25, 2.05)*
Skin cancer	*1.41 (1.01, 1.95)*	0.80 (0.56, 1.14)	1.11 (0.73, 1.67)	*0.57 (0.48, 0.68)*	0.79 (0.60, 1.04)	*1.38 (1.01, 1.88)*
Other cancer	*3.03 (2.26, 4.06)*	*2.16 (1.54, 3.03)*	*3.14 (2.07, 4.77)*	*0.71 (0.58, 0.88)*	1.04 (0.75, 1.43)	*1.45 (1.01, 2.09)*

Significant results are shown in bold italic font.
*

Other means American Indian, Native Hawaiian, Asian, Multiracial and ‘Other’.
†

Single includes divorced, widowed, separated, and never married.
‡

‘Unemployed, not looking’ includes ‘Homemaker, Student, and Retired’, ‘Unemployed, looking’ includes out of work over a year and out of work less than a year.
§

Persons may have more than one condition or cancer.