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Construct Overview of Cancer Screening

Please note that this section is an archive and is no longer being updated.

Background

Cancer screening refers to a set of procedures administered to detect cancer. The goal of cancer screening is to detect the disease in an early stage of its natural history.¹ The earlier that cancer can be detected from various screening procedures, the more effective the treatment can be and this may result in a better final outcome.¹ The most common cancers and cancers that are most readily screened for include: colon cancer, breast cancer, prostate cancer, and lung cancer. There are some advantages and disadvantages of cancer screening. One advantage is that screening for cancer can allow for an earlier diagnosis and this may lead to appropriate and timely treatment that could extend one's life.² The disadvantage includes the risk of having a false positive result. A false positive result occurs when the test is found to be positive in the absence of a disease.¹ This often causes an increased level of anxiety and unnecessary risks of treatment and costs to the patient. The estimated percentages of individuals in metropolitan areas that have screenings for cancer include the following: 64.6% to 82.0% receive mammograms to detect breast cancer, 77.2% to 91.7% receive Pap test to detect cervical cancer, 9.9% to 35.2% receive fecal blood tests, and 17.3% to 43.3% receive colonoscopy to detect colorectal cancer.³

VA Relevance

Research suggests that in the US, 60% of cancer patients and 80% of all cancer-related deaths occur in 12% of individuals who are 65 years of age or older.⁴ Screening for breast cancer, colorectal cancer, and prostate cancer have been utilized both in the veteran population and in the general population.⁵ Screening for prostate cancer and colorectal cancer has been most readily studied with the veteran population. One study focused on the whether a health care provider-directed intervention increased colorectal cancer screening among veterans. The study found that a provider directed intervention and feedback with a patient increased colorectal cancer screening rates of veterans.⁶ Another study focused on the whether there were any racial or ethnic differences in colorectal cancer screening with male veterans. The researchers found that within the veteran male population, African-American patients were 1.3 times more likely than white patients to receive colorectal cancer screenings.⁷ This result was different from what had been previously reported for the general population where African-American patients had lower rates of screening compared to white patients.⁷ Breast cancer is another cancer that is highly prevalent in our society. Research has found that education, income, insurance, and perceived risk of breast cancer are directly related to breast cancer screening in women veterans aged 50 years or over.⁸ Cancer screening within the veteran population as in the general population is important because screening can result in early detection of the disease and would increase one's life expectancy with proper care and treatment. Cancer screening among the veteran population and within the general population can evoke feelings of anxiety and thus many can benefit from support through the screening cancer detection process.⁹

Measurement

Various screening procedures have been developed to detect the different types of cancer. Breast cancer screening is often done by self-examination or having regular mammograms. Colorectal cancer is screened using fecal occult blood testing and colonoscopy.² A digital rectal exam (DRE) along with prostate specific antigen (PSA) can be used to screen for prostate cancer. Computed Tomography (CT) is used to detect cancer in the body by offering detailed pictures of structures in the body.¹⁰

Structured interviews enable clinicians to accurately obtain information about a patient. Self-administration of instruments can allow patients to report their own symptoms in a clear manner. Some of the instruments that have been used in patients with prostate cancer have been found to be valid and reliable.12 Therefore, the quality of life in patients with prostate cancer may be measured more precisely.

Through literature review, METRIC identified commonly used methods used to screen for cancer. What follows is a brief summary of each screening procedure and the type of cancer that it is used to detect.

Relevant Cancer Screening Methods

1. Mammogram
2. Fecal occult blood testing
3. Colonoscopy
4. Digital Rectal Exam

1. Kemp C, Potyk D. Cancer Screening: Principles and Controversies. The Nurse Practitioner. 2005; August: 30(8): 46-50. [Abstract]
2. Hall HI, Van Den Eeden S, Tolsma DD, Rardin K, Thompson T, Sinclair AH, Madlon-Kay DJ, Nadel M. Testing for Prostate and Colorectal Cancer: Comparison of Self-Report and Medical Record Audit. Preventive Medicine. 2004; 39: 27-35. [Abstract]
3. Nelson DE, Bolen J, Marcus S, Wells HE, Meissner H. Cancer Screening Estimates for U.S. Metropolitan Areas. American Journal of Preventative Medicine. 2003; 24(4): 301-309. [Abstract]
4. Carreca I, Balducci L, Extermann M. Cancer in the Older Person. Cancer Treatment Reviews. 2005; 31: 380-402. [Abstract]
5. Breen N, Wagener DK, Brown ML, Davis WW, Ballard-Barbash R. Progress in Cancer Screening Over a Decade: Results of Cancer Screening From 1987, 1992, and 1998 National Health Interview Surveys. Journal of the National Cancer Institute. 2001; November: 93(22): 1704-1713. [Abstract]
6. Ferreira MR, Dolan NC, Fitzgibbon ML, Davis TC, Gorby N, Ladewski L, Liu D, Rademaker AW, Medio F, Schmitt BP, Bennett CL. Health Care Provider Directed Intervention to Increase Colorectal Cancer Screening Among Veterans: Results of a Randomized Controlled Trail. Journal of Clinical Oncology. 2005; March: 23(7): 1548-1554. [Abstract]
7. Dolan NC, Ferreira R, Fitzgibbon ML, Davis TC, Rademaker AW, Liu D, Lee J, Wolf M, Schmitt BP, Bennett CL. Colorectal Cancer Screening Among African-American and White Male Veterans. American Journal of Preventive Medicine. 2005; 28(5): 479-482. [Abstract]
8. Lairson DR, Chan W, Newmark GR. Determinants of the Demand for Breast Cancer Screening among Women Veterans in the United States. Social Science & Medicine. 2005; 61: 1608-1617. [Abstract]
9. Dale W, Bilir P, Han M, Meltzer D. The Role of Anxiety in Prostate Carcinoma: A Structured Review of the Literature. Cancer. 2005; 104(3): 467-478. [Abstract]
10. Zoorob R, Anderson R, Cefalu C, Sidani M. Cancer screening guidelines. Am Fam Physician. 2001 Mar 15;63(6):1101-12. [Abstract]