Delivery of Cancer Screening

BACKGROUND: Patients and physicians strongly endorse the importance of preventive or periodic health examinations (PHEs). However, the extent to which PHEs contribute to the delivery of cancer screening is uncertain. METHODS: In a retrospective cohort study, we determined the association between receipt of a PHE and cancer testing in a population-based sample of enrollees in a Washington State health plan who were aged 52 to 78 years and eligible for colorectal, breast, or prostate cancer screening in 2002-2003 (N = 64 288). Outcomes included completion of any colorectal cancer testing (fecal occult blood testing, sigmoidoscopy, colonoscopy, or barium enema), screening mammography, and prostate-specific antigen testing. RESULTS: More than half (52.4%) of the enrollees received a PHE during the study period. After adjusting for demographics, comorbidity, number of outpatient visits, and historical preventive service use before January 1, 2002, receipt of a PHE was significantly associated with completion of colorectal cancer testing (incidence difference, 40.4% 95% confidence interval (CI), 39.4%-41.3%; relative incidence, 3.47 95% CI, 3.34-3.59), screening mammography incidence difference, 14.2% [95% CI, 12.7%-15.7%; relative incidence, 1.23 95% CI, 1.20-1.25), and prostate-specific antigen testing (incidence difference, 39.4% 95% CI, 38.3%-40.5%; relative incidence, 3.06 95% CI, 2.95-3.18). CONCLUSIONS: Among managed care enrollees eligible for cancer screening, PHE receipt is associated with completion of colorectal, breast, and prostate cancer testing. In similar populations, the PHE may serve as a clinically important forum for the promotion of evidence-based colorectal cancer and breast cancer screening and of screening with relatively less empirical support, such as prostate cancer screening.