Each year, many Americans make resolutions to improve their health.  For some adults this means quitting smoking or drinking, for others it means changing their diet and exercise.  But for all adults, taking preventative health measures should be the first step in maintaining and improving one’s health.  By receiving recommended yearly examinations, doctors can diagnose potential health problems, such as high blood pressure, high cholesterol, and cancer.  With early detection, these problems can be successfully treated, but without routine exams they often remain undiagnosed and untreated.

The following article examines data from PHMC’s Community Health Data Base 2002 Household Health Survey about adults in Southeastern Pennsylvania (SEPA) who have not received recommended health screenings for cancer, blood pressure, and cholesterol. 

Cancer Screenings:

Cancer is the second leading cause of death among adults in the United States.  According to the American Cancer Society, it is estimated that one out of every two men and one out of every three women will develop some form of cancer during their lifetime (1).  Given the high risk of developing cancer and the benefits of early detection, doctors recommend that adults receive several routine exams to screen for cancer.

Among women, breast cancer is the most frequently diagnosed form of cancer – with a projected 267,000 new cases in 2003(2).  When detected at the localized stages, however, the five-year survival rate for women with breast cancer is now 97% (as compared to 79% when cancer is diagnosed at the regional stage)(3).  In order to detect cancer early, doctors recommend a yearly breast examination performed by a doctor or health professional for women ages 18 and older as well as a yearly mammogram for women ages 40 and older and women with a family history of breast cancer.  To screen for cervical cancer, doctors recommend that women ages 18 and older receive a yearly pap smear. 

Early detection and treatment are the keys to surviving cancer, yet according to results from the 2002 Southeastern Pennsylvania Household Health Survey many adults in the region do not receive these recommended screenings:  (See Figure 1)

• One out of four women ages 18 and older have not had a breast exam in the past year (24.2%).  This represents approximately 369,200 women in the region.  Additionally, one out of three women ages 40 years and older have not had their recommended annual mammogram (32.9%). 
• In SEPA, thirty percent of women ages 18 and older have not had a Pap smear in the past year to screen for cervical cancer (30.3%).

Among men, the lifetime probability of developing prostate cancer is one in six.  Therefore, doctors recommend that men ages 50 and older receive a yearly prostate exam.  Additionally, both men and women ages 50 and older are advised to receive a blood stool test once every two years and a colonoscopy or sigmoidoscopy once every five years to detect colorectal cancer.

• Thirty percent of men ages 50 years and older have not had a prostate exam within the last year (30.2%).  This represents approximately 155,400 men in the region.
• Among adults ages 50 and older, 32.8% of men have not had a blood stool test for colorectal cancer in the past two years as compared to 41% of women.  Over fifty percent of women ages 50 and older did not receive a colonoscopy or sigmoidoscopy (53.9%) as compared to 43.4% of men.
• When asked why they did not receive these cancer screenings in the recommended times, the most common response among both men and women was that they felt they did not need the screening.  Many adults also reported that the screenings either cost too much money, or that a lack of motivation was keeping them from getting the exams.

Insurance Status:  Uninsured adults in Southeastern Pennsylvania are much less likely than insured adults to receive routine screenings for cancer. (See Figure2)

• Uninsured women were more than twice as likely as insured women to go without a breast exam (47.9% versus 22.6%) and mammogram (63.7% versus 31.6%) in the past year.
• Nearly half of all uninsured women did not receive a Pap smear in the past year (49.1%) as compared to 28.9% of insured women. 
• An alarming 84.1% of uninsured men did not receive a prostate exam in the past year, as compared to only 29% of insured men.

Race:  Among both men and women, Asian adults are much more likely to report going without the recommended cancer screenings, while black adults are the least likely to report going without these exams.

• Black and Latino women are the least likely to go without their yearly Pap smear.  Among women ages 18 and older, 22.9% of black women, 23.9% of Latino women, 32.5% of white women, and 41.3% of Asian women did not have a Pap smear in the past year.
• Black women are also the least likely to go without their recommended screenings for breast cancer.  Approximately one out of five black women did not receive a breast exam in the past year (21.1%) as compared to 24.3% of white women, 27.4% of Latino women and 41.7% of Asian women.   As for mammograms, 30% of black women ages 40 and older did not receive their annual mammogram, as compared to 33.4% of white women, 35.9% of Latino women and 40.3% of Asian women.
• Thirty percent of white men and black men ages 50 years and older did not receive their yearly prostate exam (29.4% and 29.2%, respectively).  Latino and Asian men were much more likely to go without their recommended prostate exam (44.8% and 60.8% respectively).

Blood Pressure and Cholesterol Tests:

One in four U.S. adults have high blood pressure, yet an estimated one-third of adults with high blood pressure are not aware of their condition (4).   High blood pressure is often called the “silent killer” because there are no symptoms, yet when untreated, high blood pressure can cause stroke, heart attack, heart failure, or kidney failure (5).  Routine blood pressure tests, therefore, are critical to maintaining one’s health.

In addition to high blood pressure, approximately 42 million U.S. adults have high cholesterol (6).  Like high blood pressure, many adults do not consider high cholesterol to be a serious or life-threatening problem, however, cholesterol causes an increased risk of heart disease – the leading cause of death among adults in the United States.  Routine cholesterol tests, therefore, are also very important to maintaining health.

Results from the 2002 Southeastern Pennsylvania Household Health Survey reveal that while only one out of ten adults in the region did not receive a blood pressure reading in the past year (9.6%), one-third of adults did not receive a yearly cholesterol test (33.1%).  

• In the past year, 7.2% of women did not have a blood pressure reading as compared to 12.4% of men.  Of those who did not receive a blood pressure reading, 55.8% believed that they did not need the test.
• One out of three men (33.6%) and women (32.5%) did not have a cholesterol test in the past year.  Of those who did not receive a cholesterol reading, 41.8% believed they did not need it.

Insurance Status:  Uninsured adults in Southeastern Pennsylvania are much less likely than insured adults to receive routine screenings for cancer, high blood pressure, and high cholesterol. 

• Less than ten percent of adults with insurance did not have a blood pressure reading in the past year (8.3%) as compared to one-quarter of uninsured adults (26.1%)
• Twice as many uninsured adults did not have a cholesterol test in the past year as compared to insured adults (60.9% versus 30.9%).

Race:  Among both men and women, Asian adults are much more likely to go without the recommended screenings, while black adults are the least likely to go without the recommended screenings. (See Figure3)

• Only 6.7% of black adults did not receive a blood pressure reading in the past year, as compared to 9.4% of white adults, 14.9% of Latino adults, and 23.3% of Asian adults.
• One quarter of black adults have not received a cholesterol check in the past year (25.1%) as compared to 34.4% of white adults, 36.8% of Latino adults and 46.4% of Asian adults.

By receiving routine exams to screen for high blood pressure, high cholesterol, and cancer, doctors can detect potential problems and treat them before they become more serious.  Because these conditions often do not display outward symptoms during the early stages, without preventative screenings, early detection is not likely.  In order to best maintain one’s health, as the new year begins, make preventative health screenings a resolution you will keep.  For information regarding PHMC’s Community Health Data Base 2002 Household Health Survey, or to learn more about preventative health screenings, contact Diana Levengood, at (215) 731-2039 or dianal@phmc.org.

Notes:
1. Cancer Statistics 2003. American Cancer Society, 2003.
2. Breast Cancer Facts and Figures 2003-2004.  American Cancer Society, 2003.
3. Breast Cancer Facts and Figures 2003-2004.  American Cancer Society, 2003.
4. High Blood Pressure Statistics, American Heart Association, 2003.
5. High Blood Pressure Statistics, American Heart Association, 2003.
6. Cholesterol Statistics, American Heart Association, 2003.