Cancer Screening and Treatment in Women: Recent Findings
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).
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).
Evidence does not support use of
genomic tests to detect ovarian cancer..
Description: According to this scientific review, there
is no evidence relevant to the impact of
genomic tests for ovarian cancer on
health outcomes in asymptomatic
women. The researchers used model
simulations to predict the usefulness
and efficacy of genomic tests for
ovarian cancer. The model simulations
suggest that annual screening, even with
a highly sensitive test, will not reduce
ovarian cancer mortality, and that
frequent screening has a very low
positive predictive value.
Source: Genomic Tests
for Ovarian Cancer Detection and
Management, Evidence Report/Technology Assessment No. 145
(AHRQ Publication No. 07-E001)* (AHRQ Contract 290-02-0025).
Breast and gynecologic cancers account
for one-fourth of all cancer
hospitalizations among women.
Description: This publication summarizes findings
on hospital use, outpatient surgery use,
hospital charges, and changing practice
patterns for the care of breast and
gynecologic cancers in U.S. women.
The information is based on inpatient
hospital discharge data and outpatient
ambulatory surgery data from AHRQ's
Healthcare Cost and Utilization Project
(HCUP) and covers the period 1993-2003.
Source: Hospital and Ambulatory Surgery
Care for Women's Cancers, HCUP
Highlights No. 2 (AHRQ Publication
No. 06-0038).*
Other Cancers
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).
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).
Among older patients with early-stage
lung cancer, women live longer than
men, regardless of treatment choice.
Description: Researchers examined differences
between women and men in the natural
history of lung cancer, after controlling
for unrelated causes of death and type
of treatment among 18,967 Medicare
patients with stages I and II non-small
cell lung cancer who were diagnosed
between 1991 and 1999. They found
that the women lived longer than the
men, regardless of the type of treatment
they received, and that the women's
longer survival was independent of
differences in life expectancy between
men and women due to unrelated
causes of death. They found improved
survival advantages even among
untreated women, suggesting that lung
cancer in women has a different natural
history and potentially a different
tumor biology.
Source: Wisnivesky and Halm, J
Clin Oncol 25(13):1705-1712, 2007
(AHRQ grant HS13312).
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Cancer Screening and Diagnosis
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).
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).
Breast screening is less common in
counties that have many uninsured
women.
Description: Researchers used data from two large
surveillance systems to determine
whether screening for breast cancer
varied by the proportion of uninsured
women in the community. The data
showed that as the rate of uninsurance
in a community increased by 5 percent,
women were 5 percent less likely to
receive either clinical breast exams or
mammograms. Breast cancer screening
declined significantly for women
earning $25,000 to $75,000 who lived
in counties with high rates of
uninsurance. On the other hand, black
women and Hispanic women had
higher screening rates than white
women when they lived in
communities with low rates of
uninsurance.
Source: Schootman, Walker, Jeffe,
et al., Am J Prevent Med 33(5):379-386,
2007 (AHRQ grant HS14095).
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).
Noninvasive tests may miss breast
cancer.
Description: This report indicates that four common
noninvasive tests for breast cancer are
not accurate enough to replace biopsies
for women who receive abnormal
findings from mammography or a
clinical breast exam. Researchers found
that each of the four tests—magnetic
resonance imaging (MRI),
ultrasonography (ultrasound), positron
emission tomography scanning (PET
scan), and scintimammography (nuclear
medicine scan)—would miss a
significant number of cases of cancer,
compared with immediate biopsy, in
women at high enough risk to warrant
evaluation for breast cancer. Effectiveness
of Noninvasive Diagnostic Tests for Breast
Abnormalities, Executive Summary No.
2 (AHRQ Publication No. 06-EHC005-1)*. There is also a update of this report online at
http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=470.
* 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 ahrqpubs@ahrq.hhs.gov. Please use the AHRQ publication number when ordering.
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More Information
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
Telephone: 301-427-1503
E-mail: Beth.CollinsSharp@ahrq.hhs.gov
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. 11-P004
Replaces Publication No. 09-PB004
Current as of January 2011
Internet Citation:
Cancer Screening and Treatment in Women: Recent Findings. Program Brief. Agency for Healthcare Research and Quality, Rockville, MD. AHRQ Publication No. 11-P004, January 2011. http://www.ahrq.gov/research/cancerwom.htm
540 Gaither Road Rockville, MD 20850 