Breast and Cervical/Ovarian Cancer
- Study finds racial disparities in receipt of chemotherapy after ovarian cancer surgery.
Description: Researchers examined 11 years of data for 4,264 women aged 65 or older who were diagnosed with stage IC-IV—cancer in one or both ovaries with early signs of spreading—ovarian cancer to examine receipt of chemotherapy, which is recommended following surgery to remove the cancer. They found that just over 50 percent of black women received chemotherapy following surgery, compared with nearly 65 percent of white women; survival rates did not differ between the two groups of women, but women in the lowest socioeconomic group were more likely to die than those in the highest group.
Source: Du, Sun, Milam, et al., Int J Gynecol Cancer 18(4):660-669, 2008 (AHRQ grant HS16743).
- One type of chemotherapy for ovarian cancer carries an elevated risk for hospitalization.
Description: Researchers studied 9,361 women aged 65 and older who were diagnosed with stage IC to IV ovarian cancer between 1991 and 2002. Of the 1,694 patients who received nonplatinum chemotherapy, 8 percent were hospitalized because of a gastrointestinal ailment, compared with 6.6 percent of the 1,363 women who received platinum-based chemotherapy and 6.4 percent of the 3,094 women who received platinum-taxane therapy. Receipt of nonplatinum chemotherapy was also associated with a higher risk of hospitalization for infections, hematologic problems (e.g., anemia), and thrombocytopenia (low blood platelet count).
Source: Nurgalieva, Liu, and Du, Int J Gynecol Cancer 19(8):1314-1321, 2009 (AHRQ grant HS16743).
- Certain chemotherapy drugs used to treat ovarian cancer increase the risk of hospitalization for older women.
Description: Researchers studied 9,361 women aged 65 or older who were diagnosed with stage I to IV ovarian cancer between 1991 and 2002. Eight percent of the 1,694 women who received nonplatinum chemotherapy were hospitalized for a gastrointestinal ailment while on the chemotherapy, compared with 6.6 percent of the 1,363 women who received platinum-based chemotherapy and 6.4 percent of the 3,094 women who received platinum-taxane therapy.
Source: Nurgalieva, Liu, Du, Int J Gynecol Cancer 19(8):1314-1321, 2009 (AHRQ grant HS16743).
- Less access to effective treatment may explain poorer survival of elderly black women with ovarian cancer.
Description: Researchers studied 5,131 elderly women diagnosed with ovarian cancer between 1992 and 1999 with up to 11 years of followup. Overall, 72 percent of white women and 70 percent of black women were diagnosed with stage III or IV (advanced) disease. Among those with stage IV disease, those who underwent ovarian surgery and received adjuvant chemotherapy were 50 percent less likely to die during the followup period compared with those who did not, regardless of race. However, fewer blacks received chemotherapy than whites (50 vs. 65 percent, respectively).
Source: Du, Sun, Milam, et al., Int J Gynecol Cancer 18:660-669, 2008 (AHRQ grant HS16743).
- A survey instrument used initially with breast cancer patients is also appropriate for patients with other types of cancer.
Description: This study found that the 47-item Impact of Cancer, version 2, survey instrument, which was first tested with breast cancer survivors, may also be useful in measuring the effects of other cancers on survivors’ quality of life. Researchers gave the survey to 1,188 breast cancer survivors and 652 non-Hodgkins lymphoma survivors and found that the survey measured important and common concerns shared by both groups. Because the survey also pinpointed differences between the two groups, it is also useful for differentiating the impacts specific cancers have on survivors.
Source: Crespi, Smith, Petersen, et al., J Cancer Survivor 4(1):45-58, 2010 (AHRQ T32 HS00032).
- A family history of colon cancer does not negatively affect survival for women diagnosed with the same cancer.
Description: Researchers tracked nearly 1,400 women who were diagnosed with
invasive colon cancer and found that women who had two or more relatives with colorectal cancer appeared to have a lower risk of dying from the disease compared with women who had no family history of the cancer. Of the 262 women who had a family history of colorectal cancer, 44 died of the disease; of the 1,129 women who had no family history of the disease, 224 died. Thus, determining a family history of colorectal cancer appears to be a cost-effective way to identify individuals who may be at risk for the condition.
Source: Kirchhoff, Newcomb, Trentham-Dietz, et al., Fam Cancer 7(4):287-292, 2008 (AHRQ grant HS13853).
Return to Contents
Cancer Screening and Diagnosis
- More than half of women do not get regular mammograms.
Description: This study found that women in their 40s were more likely than women in their 50s to forgo regular mammograms, and those who rated their health as fair or poor also were more likely to skip screening, compared with women who rated their health as good or excellent. Also, dissatisfaction with a previous mammography experience reduced the likelihood of regular screening. Most of
the women participating in the study were college educated, in a higher income bracket, and insured; all of the women in the study received regular reminders about scheduling their mammograms.
Source: Gierisch, Earp, Brewer, and Rimer, Cancer Epidemiol Biomark Prevent 19(4):1103-1111, 2010 (AHRQ grant T32 HS00032). See also Meissner, Klabunde, Han, et al., Cancer 117:3101-3111, 2011 (AHRQ interagency agreement with NIH).
- Requirement for cost-sharing reduces use of mammography among some groups of women.
Description: Researchers examined data on mammography use and cost-sharing from 2002 to 2004 for more than 365,000 women covered by Medicare. Of the 174 Medicare health plans studied, just 3 required copayments of $10 or more or coinsurance of more than 20 percent in 2001; by 2004, 21 plans required cost-sharing of one form or another. The increase in coinsurance requirements correlated with a decrease in screening mammograms. Less than 70 percent of women in cost-sharing plans were screened, compared with nearly 80 percent of fully covered women. Although every demographic group was affected, black women and women with lower incomes and educations levels often were covered by plans that required cost-sharing.
Source: Trivedi, Rakowski, and Ayanian, N Engl J Med 358(4):375-383, 2008 (AHRQ grant T32 HS00020).
- Women aged 40 to 49 were responsive to changes in mammography recommendations.
Description: According to interviews with 1,451 women who received screening mammograms at one of five hospital-based clinics between October 1996 and January 1998, opinions about mammography have changed among women aged 40 to 49. Prior to the issuance of recommendations by the American Cancer Society and the National Cancer Institute that women aged 40 to 49 should receive screening mammograms every 1 or 2 years, only 49 percent of women in this age group endorsed annual screening. After the new recommendations were issued, 64 percent of women in this age group endorsed annual screening.
Source: Calvocoressi, Sun, Kasl, et al., Cancer 120(3):473-480, 2008 (AHRQ grant HS11603).
- Task Force revises recommendations for mammography.
Description: The U.S. Preventive Services Task Force updated its recommendation by calling for screening mammography, with or without clinical breast exam, every 1 to 2 years for women 40 and over. The recommendation acknowledges some risks associated with mammography, which will lessen as women age. The strongest evidence of benefit and reduced mortality from breast cancer is among women ages 50 to 69. The recommendation and materials for clinicians and patients are available at http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm (Intramural).
- Radiologists’ perception of malpractice risk appears to be higher than the actual number of lawsuits.
Description: Researchers mailed a survey in 2002 and again in 2006 to radiologists in three States—Washington, Colorado, and New Hampshire—to determine their perceived risk of facing a lawsuit related to mammogram interpretation. They found that the radiologist’s perceived risk of being sued was significantly higher than the actual number of reported malpractice cases involving breast imaging. Those who felt more at risk were more likely to have had a malpractice claim in the past or know of other radiologists who had been sued.
Source: Dick, Gallagher, Brenner, et al., Am J Roentgenol 192(2):327-333, 2009 (AHRQ grant HS10591).
- Researchers examine ways to increase breast cancer screening among Latinas.
Description: Many immigrant Hispanic women do not get yearly mammograms or perform breast self-exams. This study evaluated two interventions to address the problem: (1) use of focus groups to assess the women’s knowledge about breast cancer and identify barriers to screening and (2) participation in discussion groups, including an animated video on breast self-exam plus training in the technique using latex models. Both interventions were cost effective and successful in increasing the women’s knowledge and screening behaviors.
Source: Calderon, Bazargan, and Sangasubana, J Health Care Poor Underserved 21:76-90, 2010 (AHRQ grant HS14022).
- Radiologists’ characteristics and clinical factors influence interpretation of mammograms.
Description: This study involving 638,947 screening mammograms performed by 134
radiologists in 101 facilities found that women with clinical risk factors for breast cancer were more likely than women without risk factors to be asked to return for additional mammograms and biopsies. Increased recall rates for women with risk factors did not lead to a higher probability of detecting cancer.
Recall rates were also higher when the radiologist was younger, had interpreted more mammograms per year, and was affiliated with a teaching institution.
Source: Cook, Elmore, Miglioretti, et al., J Clin Epidemiol 63(4):441-451, 2010 (AHRQ grant HS10591).
- Study finds no correlation between abnormal mammogram interpretation and radiologists’ job satisfaction.
Description: In this study, 131 radiologists were surveyed about their clinical practices and attitudes related to screening mammography. Performance data were used to determine the odds of an abnormal mammogram interpretation. More than half of the radiologists said they enjoyed interpreting screening mammograms; most in this group were female, older, and working part time; affiliated with academic medical centers; and/or on an annual salary. Those who did not enjoy the work reported it as being tedious. There were no significant differences in mammogram interpretation and cancer detection between those who did and did not enjoy their work.
Source: Geller, Bowles, Sohng, et al., Am J Roentgenol 192(2):361-369, 2009 (AHRQ grant HS10591).
- Less than 15 percent of radiologists say they definitely would tell a patient about an error in mammogram interpretation.
Description: A survey of 243 radiologists at seven geographically dispersed breast cancer surveillance sites found that 9 percent of those surveyed definitely would not disclose an error in mammogram interpretation; 51 percent would disclose the error only if specifically asked by the patient; 26 percent said they probably would disclose the error; and just 14 percent said they definitely
would disclose the error.
Source: Gallagher, Cook, Brenner, et al., Radiology 253(2):443-452, 2009 (AHRQ grant HS10591).
- Automated telephone reminders lead to increased use of mammography.
Description: Researchers tested the effectiveness of automated telephone reminders (ATRs), enhanced reminder letters, and standard letters on the likelihood of repeat mammograms in 3,547 women who were randomly assigned to one of the three groups. The ATRs were found to be the least costly but most effective (76 percent) intervention for prompting repeat mammograms compared with the enhanced (72 percent) and standard (74 percent) reminder letters. Overall, 74 percent of women had a repeat mammogram within 10-14 months compared with 57 percent before the reminders.
Source: DeFrank, Rimer, Gierisch, et al., Am J Prevent Med 36(6):459-467, 2009 (AHRQ grant T32 HS00079).
- In St. Louis, black women are more likely than white women to receive mammograms.
Description: St. Louis, MO, is known to have high rates of breast cancer diagnosed at a late-stage, and researchers have been looking at ways to increase mammography use in late-stage diagnosis areas. From March 2004 to June 2006, researchers conducted a survey of women (429 black, 556 white) older than age 40 living in the St. Louis area. Unexpectedly, more black women (75
percent) than white women (68 percent) reported that they had received mammograms.
Source: Lian, Jeffe, and Schootman, J Urban Health 85(5):677-692, 2008 (AHRQ grant HS14095).
- Women’s perception of risk affects screening for colon cancer but not cervical or breast cancer.
Description: Researchers interviewed 1,160 white, black, Hispanic, and Asian women (aged 50 to 80) about their perceived risk for breast, cervical, and colon cancer and compared their perceived risk with their screening behavior. The women’s perceived lifetime risk of cancer varied by ethnicity, with Asian women generally perceiving the lowest risk and Hispanic women the highest risk for all three types of cancer. Nearly 90 percent of women reported having a mammogram, and about 70 percent of the women reported having a Pap test in the previous 2 years; 70 percent of the women were current with colon
cancer screening. There was no relationship between screening and perception of risk for cervical or breast cancer; however, a moderate to very high perception for colon cancer risk was associated with nearly three times higher odds of having undergone colonoscopy within the last 10 years.
Source: Kim, Perez-Stable, Wong, et al., Arch Int Med 168(7):728-734, 2008 (AHRQ grant HS10856).
- Instituting new processes can reduce diagnostic errors in Pap smear interpretation.
Description: Lean methods are used to weigh the expenditure of resources against value received. For this study, researchers compared the diagnostic accuracy of Pap tests procured by five clinicians before (5,384 controls) and after (5,442 cases) implementing a process redesign using Lean methods. Following process redesign, there was a significant improvement in Pap smear quality, and
the case group showed a 114 percent increase in newly detected cervical intraepithelial cancer following a previous benign Pap test.
Source: Raab, Andrew-Jaja, Grzybicki, et al, J Low Genit Tract Dis 12(2):103-110, 2008 (AHRQ grant HS13321).
- Physicians and patients may not be adhering to recommendations for less frequent Pap testing.
Description: Increased understanding of cervical cancer has led professional organizations to revise clinical guidelines to allow for Pap test intervals of 2 to 3 years after the age of 30 for women who have had three consecutive normal Pap tests. However, recent reports suggest that many physicians are continuing to screen annually. This study found that only 32 percent of physicians had
adopted a 3-year Pap test interval. Women older than age 65 were more willing than younger women to follow a 3-year interval.
Source: Meissner, Tiro, Yabroff, et al., Med Care 48(3):249-259, 2010. See also Saraiya, Berkowitz, Yabroff, et al., Arch Intern Med 170(11):977-986 (Intramural).
- Many homeless women decline the offer of free cervical cancer screening.
Description: Homeless women have higher rates of cervical cancer than other women, yet even when barriers to cervical screening are removed, many homeless women do not take advantage of free Pap smears. The researchers collected medical and demographic information on 205 homeless women who had been admitted to a medical facility; 129 of the women met the criteria for Pap testing. Only 80 of the women (62 percent) agreed to the testing, and just 56 of the women (70 percent) actually had the test performed.
Source: Bharel, Casey, and Wittenberg, J Women’s Health 18(12):2011-2016, 2010 (AHRQ HS14010).
- Less than 25 percent of physicians report guideline-consistent recommendations for cervical cancer screening.
Description: Researchers used a large, nationally representative sample of primary care physicians to identify current Pap test screening practices in 2006-2007. They used clinical vignettes to describe women by age and sexual and screening history to elicit physicians' recommendations. Guideline-consistent recommendations varied by physician specialty: obstetrics/gynecology 16.4 percent, internal medicine 27.5 percent, and family/general practice 21.1 percent.
Source: Yabroff, Saraiya, Mesisner, et al., Ann Intern Med 151(9):602-611, 2009 (AHRQ grant HS10565).
- A majority of older women think lifelong cervical cancer screening is important.
Description: Researchers conducted face-to-face interviews with 199 women aged 65 and older to determine their views about continuing to receive Pap tests to screen for cervical cancer. Most of the women were minorities, and about 45 percent were Asian. Despite recent changes in clinical recommendations to stop Pap screening in women older than 65, more than two thirds of the women in this study felt that lifelong screening was either important or very important. Most of the women (77 percent) planned on being screened for the rest of their lives.
Source: Sawaya, Iwaoka-Scott, Kim, et al., Am J Obstet Gynecol 200(1):40.e1-40.e7, 2009. See also Huang, Perez-Stable, Kim, et al., J Gen Intern Med 23(9):1324-1329, 2008 (AHRQ grant HS10856).
* Items marked with an asterisk are available free from the AHRQ Clearinghouse. To order, contact the Clearinghouse at 800-358-9295 or request electronically by sending an e-mail to email@example.com. Please use the AHRQ publication number when ordering.
Return to Contents
For more information on AHRQ initiatives related to women's health, please contact:
Beth Collins Sharp, Ph.D., R.N.
Senior Advisor, Women's Health and Gender Research
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
For more information about AHRQ
and its research portfolio and funding
opportunities, visit the Agency's Web
site at http://www.ahrq.gov.
Return to Contents
AHRQ Publication No. 12(13)-P010-EF
(Replaces Publication No. 11-P004)
Current as of October 2012
Cancer Screening and Treatment in Women: Recent Findings. Program Brief. Agency for Healthcare Research and Quality, Rockville, MD. AHRQ Publication No. 12(13)-P010-EF, October 2012 http://www.ahrq.gov/research/cancerwom.htm