Cancer Screening and Treatment in Women: Recent Findings (continued)

Program Brief

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).

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.

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.

Current as of January 2011
Internet Citation: Cancer Screening and Treatment in Women: Recent Findings (continued): Program Brief. January 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/women/cancerwom/cancerwom2.html