Periodic Health Examination May Facilitate Cancer Screening

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March 28, 2007 — The periodic health examination (PHE) is an appropriate time for primary care clinicians to encourage cancer screening and was linked significantly with patient completion of breast and colorectal cancer screening and prostate-specific antigen (PSA) testing, according to the results of a retrospective cohort study reported in the March 26 issue of the Archives of Internal Medicine.

"Patients and physicians strongly endorse the importance of preventive or periodic health examinations (PHEs)," write Joshua J. Fenton, MD, MPH, from the University of California, Davis, in Sacramento, California, and colleagues. "However, the extent to which PHEs contribute to the delivery of cancer screening is uncertain."

The investigators determined the association between receipt of a PHE and cancer testing in a population-based cohort of 64,288 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. Endpoints included completion of any colorectal cancer testing (fecal occult blood testing, sigmoidoscopy, colonoscopy, or barium enema), screening mammography, and PSA testing.

During the study period, 52.4% of the enrollees received a PHE. Receiving a PHE was significantly associated with completion of colorectal cancer testing, after adjustment for demographics, comorbidity, number of outpatient visits, and historical preventive service use before January 1, 2002 (incidence difference, 40.4% [95% confidence interval (CI), 39.4% - 41.3%]; relative incidence, 3.47 [95% CI, 3.34 - 3.59]).

After adjustment, receiving a PHE was significantly associated with completion of screening mammography (incidence difference, 14.2% [95% CI, 12.7% - 15.7%]; relative incidence, 1.23 [95% CI, 1.20 - 1.25]) and PSA testing (incidence difference, 39.4% [95% CI, 38.3% - 40.5%]; relative incidence, 3.06 [95% CI, 2.95 - 3.18]).

"Among managed care enrollees eligible for cancer screening, PHE receipt is associated with completion of colorectal, breast, and prostate cancer testing," the authors write. "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."

Study limitations include failure to ascertain the presence of cancer symptoms, preventing the exclusion of colorectal cancer and PSA tests performed for diagnostic purposes rather than for screening; misclassification of some covariates, which may have allowed residual confounding; retrospective design without randomization; lack of generalizability to uninsured populations or fee-for-service settings; and difficulty comparing these findings with publicly reported quality measures (eg, the Health Plan Employer Data and Information Set).

"Experimental studies could confirm the efficacy of the PHE in health promotion, elucidate the ideal content of PHEs, and guide the development of interventions to help physicians make the most of PHEs," the authors conclude.

The National Cancer Institute Cancer Research Network, the American Cancer Society, and the National Cancer Institute supported this study. The authors have disclosed no relevant financial relationships.

Arch Intern Med. 2007;167:580-585.

Source: http://www.medscape.com/viewarticle/554226?src=mp