The relationship between age and cancer
screening in the US and Europe
David H. Howard
Kenneth E. Thorpe
Emory University
Lisa Richardson
CDC
How did an abstract about chronic disease rates become a
talk about cancer screening?
•
Chronic disease rates are higher in the U.S.
•
Rates may be higher because
1) people in the U.S. are sicker
2) U.S. patients are screened and treated for “mild” disease
•
We’d like to know if patients in the U.S. are over-treated or if
patients in Europe are under-treated
•
Cancer screening provides a good opportunity to address this
question.
Diagnosed disease rates in the 50+ population
0.60
US
Europe
0.50
0.40
0.30
0.20
0.10
0.00
Cancer
High
blood
pressure
Diabetes
Stroke
Lung
disease
Data sources
Dataset
Year
Sample age 50+
Males Females Total
2004
2004
1998
2004
1998
7,814 10,485 18,299
5,989
7,503 13,492
4,099
5,045
9,144
127,465 180,798 308,263
150,860 203,207 354,067
US
Health and Retirement Survey (HRS)
Medical Expenditure Panel Survey (MEPS)
Medical Expenditure Panel Survey (MEPS)
SEER-Medicare 5% file (SEER-MCR)
SEER-Medicare 5% file (SEER-MCR)
Europe
Survey of Health and Ageing in Europe (SHARE) 2004
Eurobarometer (EURO)
1998
9,873
4,170
11,839
4,531
21,712
8,701
Screening measures
Measure
Questions
Medicare claim codes
Mammography in the
HRS: In the last two years, did you have a mammogram or x-ray of the breast?
previous 2 years (2004) or in SHARE: In the last two years, have you had a mammogram (x-ray of the breast)?
the previous year (1998)
MEPS: A mammogram is an x-ray taken only of the breast by a machine that presses
the breast against a plate. About how long has it been since you had a mammogram?
EURO: Which of the following examinations have you had in the last twelve months?
Examination of the breast with x-rays, that is, mammography.
HCPCS: 76090-79092, 76082,
76083, 76085, G0202, G0204,
G0206
ICD-9: 87.3
Colonoscopy/
Sigmoidoscopy in the
previous 10 years (Europe)
or 5 years (U.S.)
MEPS: A sigmoidoscopy or colonoscopy is when a tube is inserted in the rectum to
view the bowel for signs of cancer or other health problems. When did you have your
last sigmoidoscopy or colonoscopy?
SHARE: Have you ever had a sigmoidoscopy or colonoscopy? If so, about how long
ago did you have the most recent one?
HCPCS: 45355, 45378-45380,
45382-45385, G0105, G0121
ICD-9: 45.22, 45.23, 45.42,
45.43, 45.25, 45.41
Pap Smear in the previous
year
MEPS: A Pap or Papaniculou smear is a test used to screen for cervical cancer. About
how long has it been since you had a pap smear test?
EURO: Which of the following examinations have you had in the last twelve months?
Cervical smear test?
HCPCS: 88141-88145, 88147,
88148, 88150, 88152-88155,
88164-88167, G0101, G0123,
G0124, G0141, G0143-G0145,
G0147, G0148, Q0091, P3000,
P3001
ICD-9: 91.46, V76.2
Prostate exam in the
previous 3 years
MEPS: Prostate exam: A rectal examination to check the prostate gland for
inflammation, enlargement, or cancer. About how long has it been since you had a
prostate exam?
EURO: In the last three years, have you had a manual examination to detect prostate
cancer?
NA
Screening levels in the U.S. and Europe
Age range:
Year:
Europe (%)
U.S. (%)
MEPS
HRS
Europe/US ratio
Colonoscopy
Pap
Mammography
Sigmoidoscopy smear
50-99
50-84
50-99
50-84
2004
1998
2004
1998
Prostate
exam
50-84
1998
40
27
12
26
26
76
76
60
--
37
--
56
--
64
--
0.53
0.46
0.31
0.46
0.41
Receipt of mammography in the previous two years, 2004
90
80
Percent screened
70
US: MEPS
US: HRS
US: SEER-MCR
E: SHARE
60
50
40
30
20
10
0
40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94
Receipt of mammography in the previous year, 1998
70
60
Percent screened
50
US: MEPS
US: SEER-MCR
E: EURO
40
30
20
10
0
40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94
Receipt of colonoscopy/sigmiodoscopy in the previous 5 years
(US) or 10 years (Europe), 2004
60
Percent screened
50
40
US: MEPS
US: SEER-MCR
E: SHARE
30
20
10
0
40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94
Receipt of cervical cancer screening in the previous
year, 1998
70
60
Percent screened
50
US: MEPS
US: SEER-MCR
E: EURO
40
30
20
10
0
40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94
Conclusions
• Cancer screening is under-used in Europe, as indicated by low
screening rates in age groups where screening has the greatest
potential to improve longevity
• Cancer screening is overused in the U.S., as indicated by higher
screening rates in age groups where the value of screening is
questionable
Receipt of colonoscopy/sigmiodoscopy in the previous 5 years
(US) or 10 years (Europe), 2004
60
Percent screened
50
40
US: MEPS
US: SEER-MCR
E: SHARE
30
20
10
0
40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94