Morbidity And Mortality Weekly Report

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Morbidity and Mortality Weekly ReportWeekly / Vol. 70 / No. 2January 15, 2021Cancer Screening Test Receipt — United States, 2018Susan A. Sabatino, MD1; Trevor D. Thompson1; Mary C. White, ScD1; Jean A. Shapiro, PhD1; Janet de Moor, PhD2;V. Paul Doria-Rose, DVM, PhD2; Tainya Clarke, PhD3; Lisa C. Richardson, MD1Screening for breast cancer, cervical cancer, and colorectalcancer (CRC) reduces mortality from these cancers.* However,screening test receipt has been below national targets with disparities observed in certain populations (1,2). National HealthInterview Survey (NHIS) data from 2018 were analyzed toestimate percentages of adults up to date with U.S. PreventiveServices Task Force (USPSTF) screening recommendations.Screening test receipt remained below national Healthy People2020 (HP2020) targets, although CRC test receipt nearedthe target. Disparities were evident, with particularly low testreceipt among persons who were uninsured or did not haveusual sources of care. Continued monitoring helps assessprogress toward targets and could inform efforts to promotescreening and reduce barriers for underserved populations.Data from the 2018 NHIS, an annual survey of a nationallyrepresentative sample of the civilian, noninstitutionalized U.S.population,† were used to examine up-to-date breast, cervical,and colorectal cancer screening test receipt per USPSTF recommendations. Information about tests was collected from onerandomly selected adult per family (final sample adult responserate was 53.1%) (3). Respondents were asked whether theyhad ever received each test and when they received their mostrecent test. Respondents with a personal history of the cancerin question were excluded from analysis for that cancer type.Percentages with Korn-Graubard confidence intervals (4) arepresented overall and by sociodemographic and health careaccess factors. Percentages of respondents who were up to datewith screening were also age-standardized to the 2000 U.S.standard population, consistent with HP2020 cancer screening* el--5; panel--8; p-panel--5.† https://www.cdc.gov/nchs/nhis/nhis 2018 data release.htm.measures. NHIS-imputed income files were used. NHIS datafrom 2005, 2008, 2010, 2013, 2015, and 2018 were used toexamine differences across years in percentages of persons whowere up to date with screening, according to USPSTF recommendations in effect for each year. For 2018, “up-to-date”status was defined as receipt of the following: mammographywithin 2 years among women aged 50–74 years for breastcancer screening; Pap test within 3 years for women aged21–65 years or Pap test plus human papillomavirus (HPV) test(co-testing) within 5 years for women aged 30–65 years for cervical cancer screening (among women without hysterectomy);INSIDE36 CDC’s Emergency Management Program Activities —Worldwide, 2013–201840 Assessment of Neonatal Abstinence SyndromeSurveillance — Pennsylvania, 201946 Allergic Reactions Including Anaphylaxis AfterReceipt of the First Dose of Pfizer-BioNTechCOVID-19 Vaccine — United States,December 14–23, 202052 Rates of COVID-19 Among Residents and StaffMembers in Nursing Homes — United States,May 25–November 22, 202056 Candida auris Outbreak in a COVID-19 Specialty CareUnit — Florida, July–August 202058 Mitigation Policies and COVID-19–AssociatedMortality — 37 European Countries, January 23–June 30, 202064 QuickStatsContinuing Education examination available athttps://www.cdc.gov/mmwr/mmwr continuingEducation.htmlU.S. Department of Health and Human ServicesCenters for Disease Control and Prevention

Morbidity and Mortality Weekly Reportand home blood stool or fecal immunochemical test (FIT)within 1 year; colonoscopy within 10 years; computed tomography (CT) colonography, or sigmoidoscopy within 5 years; orFIT-DNA test within 3 years among adults aged 50–75 yearsfor CRC screening.In August 2018, USPSTF added HPV testing alone as acervical cancer screening option for women aged 30–65 years§;however, because this analysis used data collected beginningJanuary 2018 regarding screening in the preceding 3–5 years,this option was not included. Wald F tests were used to testfor any differences across years (treated categorically) andgroups. Sample adult weights and design variables were usedto account for the complex sample design. Estimates not meeting National Center for Health Statistics data presentationstandards for proportions were suppressed (4). All analyseswere performed using SAS (version 9.4; SAS Institute) andSUDAAN (version 11.0.3; RTI International).Among women aged 50–74 years, 72.4% were up to date withmammography (age-standardized 72.3%) (Table 1), which isbelow the HP2020 target (81.1%). Lower test receipt was associated with having lower educational attainment and income, nothaving a usual source of care, and being uninsured or having onlypublic health insurance coverage. Approximately 30%–40%of women without a usual source of care or health insurance§ ecommendation/cervical-cancer-screening.coverage were up to date. Although the percentage of women upto date with mammography has not varied substantially by year(Figure), the absolute number of women who received a mammogram has increased. The estimated number of women tested(numerator) was 4,097,142 in 2005 and 5,558,224 in 2018,reflecting growth in the population of women aged 50–74 years(denominator) age-eligible for testing.Among women aged 21–65 years, 82.9% were up to datewith cervical cancer screening (age-standardized 83.4%)(Table 1), which is below the HP2020 target (93.0%). Lowertest receipt was associated with younger and older age groups,Asian race, lower educational attainment and income, shorterU.S. residence, gay or lesbian sexual orientation, no usualsource of care, and being uninsured or having only publicinsurance coverage. Cervical cancer test receipt varied from2005 to 2018 (Figure), with declines from 85.3% in 2005to 80.5% in 2013, followed by an increase (82.9% in 2018).Among adults aged 50–75 years, 66.9% were up to date withCRC testing (age-standardized 66.7%) (Table 2), nearing theHP2020 target (70.5%). Lower test receipt was associated withage 50–64 years, American Indian/Alaska Native or Asian race,Hispanic ethnicity, lower educational attainment or income,non-U.S. birthplace, no usual source of care, and non-militaryhealth insurance coverage or no insurance. Approximately 30%of those without a usual source of care or health insurance wereup to date. Test receipt increased since 2005 (46.6%) (Figure).The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC),U.S. Department of Health and Human Services, Atlanta, GA 30329-4027.Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR Morb Mortal Wkly Rep 2021;70:[inclusive page numbers].Centers for Disease Control and PreventionRobert R. Redfield, MD, DirectorAnne Schuchat, MD, Principal Deputy DirectorIleana Arias, PhD, Acting Deputy Director for Public Health Science and SurveillanceRebecca Bunnell, PhD, MEd, Director, Office of ScienceJennifer Layden, MD, PhD, Deputy Director, Office of ScienceMichael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory ServicesMMWR Editorial and Production Staff (Weekly)Charlotte K. Kent, PhD, MPH, Editor in ChiefJacqueline Gindler, MD, EditorPaul Z. Siegel, MD, MPH, Guest Associate EditorMary Dott, MD, MPH, Online EditorTerisa F. Rutledge, Managing EditorTeresa M. Hood, MS, Acting Lead Technical Writer-EditorGlenn Damon, Soumya Dunworth, PhD,Stacy Simon, MA, Jeffrey D. Sokolow, MA,Technical Writer-EditorsMatthew L. Boulton, MD, MPHCarolyn Brooks, ScD, MAJay C. Butler, MDVirginia A. Caine, MDJonathan E. Fielding, MD, MPH, MBADavid W. Fleming, MD30Martha F. Boyd, Lead Visual Information SpecialistAlexander J. Gottardy, Maureen A. Leahy,Julia C. Martinroe, Stephen R. Spriggs, Tong Yang,Visual Information SpecialistsQuang M. Doan, MBA, Phyllis H. King,Terraye M. Starr, Moua Yang,Information Technology SpecialistsMMWR Editorial BoardTimothy F. Jones, MD, ChairmanKate Galatas, MPHWilliam E. Halperin, MD, DrPH, MPHJewel Mullen, MD, MPH, MPAJeff Niederdeppe, PhDCeleste Philip, MD, MPHPatricia Quinlisk, MD, MPHMMWR / January 15, 2021 / Vol. 69 / No. 2Ian Branam, MA, Acting LeadHealth Communication SpecialistShelton Bartley, MPH,Lowery Johnson, Amanda Ray,Jacqueline N. Sanchez, MS,Health Communication SpecialistsWill Yang, MA,Visual Information SpecialistPatrick L. Remington, MD, MPHCarlos Roig, MS, MAWilliam Schaffner, MDNathaniel Smith, MD, MPHMorgan Bobb Swanson, BSUS Department of Health and Human Services/Centers for Disease Control and Prevention

Morbidity and Mortality Weekly ReportTABLE 1. Percentage of U.S. women age-eligible for screening who were up to date with breast and cervical cancer screening, by sociodemographicand access-to-care factors — United States, 2018Cervical cancer screening†Breast cancer screening*CharacteristicOverallAge group, alue††RaceWhiteBlackAI/ANAsianMultiple Puerto RicanMexican/Mexican AmericanCentral/South AmericanOther HispanicP-value††EducationLess than high schoolHigh school/GEDSome collegeCollege degreeP-value††Federal poverty threshold, % 138 138–250 250–400 400P-value††See table footnotes on the next page.No.%§ (95% CI)No.%§ (95% CI)5,31172.4 (70.8–73.9)7,73282.9 **—**—**71.5 (69.6–73.4)74.3 (71.7–76.7)1,7171,9891,5902,436—**—**75.8 (72.8–78.7)90.1 (88.5–91.6)87.9 (85.7–89.8)79.5 (77.4–81.5)—**—**72.7 (71.0–74.3)72.9 (67.8–77.6)—§§70.5 (62.3–77.9)65.3 (52.0–77.1)5,9431,03810246017372.6 (71.0–74.2)70.7 (65.5–75.6)79.8 (67.9–88.8)70.3 (62.9–77.1)73.0 (59.2–84.1)63.9 (51.3–75.2)6,4751,25712773921717463.0 (57.7–68.1)68.6 (65.5–71.5)71.6 (68.9–74.2)80.4 (78.1–82.7)6861,4902,3443,18858.6 (54.5–62.6)66.7 (62.6–70.6)72.1 (68.5–75.5)79.5 2400.0760.5880.471 0.001 0.001DiscussionIn 2018, receipt of screening tests for breast, cervical, andcolorectal cancers was below national HP2020 targets. CRCtest receipt increased after 2005 and neared the target in 2018,whereas breast and cervical cancer test receipt remained belowtargets with little change over this period. Test receipt variedacross groups. As was also found in previous reports, testing forall three cancers decreased with decreasing educational attainment and income (1,2). Cervical cancer test receipt differed bysexual orientation, CRC test receipt varied by ethnicity, and bothdiffered by age, race, and duration of U.S. residence. Informationabout lower test receipt in some groups might help inform targeted efforts to promote screening and reduce disparities. Lowertest receipt in the youngest age groups for cervical cancer andCRC screening might, in part, reflect the transition of personswho previously did not meet screening criteria. 0.0010.0020.283 0.001 0.00183.2 (81.9–84.5)87.1 (84.0–89.7)73.6 (57.8–86.0)75.8 (70.4–80.7)77.5 (68.5–84.9)83.2 (81.9–84.5)81.4 (78.0–84.4)81.1 (72.0–88.3)78.4 (73.5–82.7)86.9 (79.8–92.2)87.3 (80.1–92.7)72.1 (67.3–76.7)78.4 (75.5–81.2)82.3 (80.2–84.2)88.2 (86.5–89.8)73.7 (70.4–76.8)78.4 (75.3–81.4)84.3 (81.8–86.5)88.2 (86.7–89.7)The lowest percentages of breast cancer and CRC screening test receipt were among respondents who lacked a usualsource of care (32.0% and 29.4% for breast cancer and CRCscreening, respectively) or health insurance coverage (39.5%and 30.2% for breast cancer and CRC screening, respectively);the largest disparities on the basis of these characteristics werefor breast cancer and CRC screening. Most persons in thesegroups were not up to date with breast cancer or CRC tests.These large disparities have persisted for years (1,2,5,6). Thenumber of persons without health insurance has declined inrecent years (7). However, among those lacking insurance or ausual source of care, most were not up to date with USPSTFbreast cancer and CRC screening recommendations. CDC’sNational Breast and Cervical Cancer Early Detection Programprovides low-income, uninsured, and underinsured womenaccess to breast and cervical cancer screening and diagnosticUS Department of Health and Human Services/Centers for Disease Control and PreventionMMWR / January 15, 2021 / Vol. 70 / No. 231

Morbidity and Mortality Weekly ReportTABLE 1. (Continued) Percentage of U.S. women age-eligible for screening who were up to date with breast and cervical cancer screening, bysociodemographic and access-to-care factors — United States, 2018Cervical cancer screening†Breast cancer screening*Characteristic%§ (95% CI)No.Duration of U.S. residence, yrs¶ 10 10Born in United StatesP-value††Sexual orientationGay or lesbianStraightBisexualOtherP-value††Usual source of ryPublic 563543,3051671,5213040.0280.304 0.001 0.001No.%§ (95% CI)—§§73.0 (68.4–77.2)72.7 (71.1–74.3)3031,1336,27365.0 (58.3–71.3)82.0 (78.9–84.8)84.3 (83.0–85.5)—§§72.6 (71.0–74.1)—§§—§§1247,2881714175.1 (73.6–76.6)32.0 (26.1–38.4)6,7051,02577.2 (75.5–78.9)78.2 (70.2–85.0)67.2 (64.2–70.2)39.5 (32.8–46.5)5,3022171,321865 0.0010.007 0.001 0.00164.7 (52.9–75.4)83.4 (82.2–84.6)79.0 (69.5–86.6)—§§85.2 (84.0–86.4)67.7 (63.9–71.3)86.4 (85.1–87.6)91.9 (86.6–95.6)79.5 (76.4–82.4)65.0 (60.6–69.1)Source: National Center for Health Statistics, National Health Interview Survey, 2018.Abbreviat