Previous cancer screening behavior as predictor of colon cancer screening among women aged 50 and over Rafael Guerrero-Preston DrPH, MPH APHA 135th Annual Meeting & Exposition November 6, 2007 Washington, DC

Colorectal cancer is the third most common type of cancer for both men and women in the United States. Close to 55,000 people are expected to die from Colorectal cancer in 2007 When colorectal cancer is detected at an early localized stage, the 5 year survival is 90% Only 39% of colorectal cancers are diagnosed at this stage, mainly due to low rates of screening The 5 year survival for persons with distant metastases drops to 10% Overview

Beginning at age 50, both men and women should follow 1 of these 5 testing schedules: 1.Yearly fecal occult blood test (FOBT) or fecal immunochemical test (FIT) 2.flexible sigmoidoscopy every 5 years 3.yearly FOBT or FIT, plus flexible sigmoidoscopy every 5 years (better than options1& 2) 4.double-contrast barium enema every 5 years 5.colonoscopy every 10 years ACS screening guidelines for colorectal cancer

Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15% ACS screening guidelines for breast cancer

Pap smears should start at age 21 or 3 years after a woman begins having vaginal intercourse. Beginning at age 30, women who have had 3 normal Pap test results in a row may get screened every 2 to 3 years Women 70 years of age or older who have had 3 or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer screening ACS screening guidelines for cervical cancer

Introduction Colon cancer screening rates in women are low (58%) when compared to cervical (84%) or breast (79%) cancer screening rates (BRFSS, 2006) Whether screening for breast and cervical cancer is associated with colon cancer screening behavior is unknown but could provide linkage opportunities

Objectives To identify the extent to which both breast and cervical cancer screening increases uptake of colon cancer screening among women in New York City

Methods A baseline cross section from the New York Cancer Project (NYCP) a prospective cohort, was utilized for this study The NYCP Database contains information on approximately 20,000 subjects aged 30 years or older recruited using venue-based sampling with quotas. The data, based on an hour-long interview, include demographics, ethnic background, personal and family medical history, reproductive history, medication use, health care utilization and screening behaviors.

This study was limited to 3,386 women ages 50+ who reported no prior history of hysterectomy, breast cancer, cervical cancer, and/or colon cancer The distribution of racial/ethnic groups in the NYCP for those older than 50 years was statistically similar to the distribution in the New York City 2000 Census. Analyses compared rates of endoscopic colon cancer screening with adherence to screening recommendations for breast and cervical cancer Methods

To assess the role of socio-demographic characteristics, access to care, and risk profile we examined the relation between each of these factors with colon cancer screening by recent cancer screening behavior, using chi-square and Fischer exact tests, as measures of significance. The role of other cancer screening behaviors as predictors of colon cancer screening were assessed with a multivariable logistic regression model, adjusted for potential confounders. Methods

Predictors of endoscopic cancer screening behavior Socio-demographic characteristics – age, education, place of residence, country of origin and race/ethnicity Access to care – income and insurance Risk profile –cancer in immediate family and history of smoking

Results Of the 3,386 women, 87.8% adhered to the other two procedures, yet only 42.1% had received endoscopic colon cancer screening. Most women with colon cancer screening (95%) also reported past mammogram and Pap-smear. Racial/ethnic disparities were evident

Cancer screening behavior by race/ethnicity

In multivariable analysis, women who adhered to the other two procedures were more likely to have had colon cancer screening than women with no prior history of cancer screening (OR = 4.4; CI = 2.36, 8.20), after accounting for age, race/ethnicity, insurance status, family history of cancer and income. Results

Results Significant predictors of endoscopic colon cancer screening included: –Age over 65 years (OR = 1.63; CI = 1.23, 2.15) with years old as the reference, –Having any health insurance (OR = 2.18; CI = 1.52, 3.13) –Family history of cancer (OR = 1.38; CI = 1.17, 1.61).

Conclusions Endoscopic colon cancer screening remains low among women over 50, even among those who undergo other screening tests The opportunity to link screening tests to encourage increased uptake of colon cancer screening merits closer attention

Acknowledgements David Vlahov and Christina Chan - The New York Academy of Medicine, Center for Urban Epidemiologic Studies Stephen Johnson – Columbia University Medical Center Maria Mitchell - AMDeC Foundation and New York Cancer Project Harold Freeman, MD - Ralph Lauren Center for Cancer Care and Prevention

Frederica Perera, Paul Brandt-Rauf, Al Neugut at Mailman School of Public Health Rafael Lantigua and Nelson Peralta at Columbia’s Center for the Active Living of Minority Elders (CALME) This research was supported in part by funds from the US federal government: –NCI grant number 5T32CA –NIA grant number 2P30AG –NCMHD grant number 5S21MD This research was also supported in part by a Presidential Scholarship from the University of Puerto Rico Acknowledgements

Gracias Thank you