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Preventive Health Visits Increase Cancer Screening

Am Fam Physician. 2007 Nov 15;76(10):1553.

Background: Preventive health examinations traditionally have consisted of a history and physical examination. More recently they have also included screening, counseling, and immunizations. There has been debate about the effectiveness of preventive health examinations. Patients and physicians view these examinations as an opportunity to improve health and build trust. In addition to other services, the preventive health examination can provide physicians with an opportunity to discuss cancer screening with patients. Although studies have found that the examination was associated with increased cancer screening, they lacked quality design and were conducted before the release of current recommendations for prostate and colorectal cancer screening. Fenton and colleagues assessed the effect of preventive health examinations on cancer screening.

The Study: This retrospective study included patients enrolled in a large group health organization that had more than 450,000 enrollees. Participants were 52 to 78 years of age, and the study period was two years. Cancer screening included colorectal cancer for men and women, breast cancer for women, and prostate cancer for men. Guidelines used for these screenings were similar to 2002 U.S. Preventive Services Task Force recommendations. To qualify for the study, patients had to have at least one primary care visit during the study. Preventive services were identified by Current Procedural Terminology codes for preventive office visits or by International Classification of Diseases, Ninth Revision, codes for general medical or gynecologic examinations. Outcome measures included completion of any colorectal cancer screening test, mammography, or a prostate-specific antigen (PSA) measurement. Comparisons were made between patients who received preventive health examinations during the study and those who did not.

Results: Of the 64,288 records reviewed for the study, 52.4 percent of patients had received preventive health examinations. There were 39,475 patients who were eligible for colorectal cancer screening, 31,379 for breast cancer screening, and 28,483 for prostate cancer screening. Those who had preventive health examinations were more likely to be younger, be a woman, have a slightly higher household income, and have fewer comorbidities. More than 37 percent of the patients who were eligible received colorectal cancer screening. However, those who had a preventive health examination were more than three times more likely to receive colorectal cancer screening compared with those who did not have an examination. Furthermore, women who had an examination were significantly more likely to receive a mammogram compared with those who did not have an examination (74.1 versus 55.9 percent). Men who had an examination were significantly more likely to receive PSA testing than those who did not have an examination (58.8 versus 21.1 percent).

Conclusion: The authors conclude that preventive health examinations are associated with a significant increase in screening for colorectal, breast, and prostate cancers. They add that these examinations may serve as an important component of cancer screening in the future.

Source

Fenton JJ, et al. Delivery of cancer screening. How important is the preventive health examination? Arch Intern Med. March 26, 2007;167:580–5.


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