• 2/11/2004
  • Schwartz LM, Woloshin S, Fowler FJ, Welch HG

Thanks in part to successful, aggressive marketing campaigns about cancer screening technology, people in the United States are enthusiastic about cancer screening, according to a national survey.

“Most people in the United States are firmly committed to cancer screening,” said Lisa M. Schwartz, MD, MS, from the Veterans Affairs Outcomes Group in White River Junction, VT. She added that false-positive results did not reduce enthusiasm for screening. Schwartz and her colleagues conducted a national telephone survey of 500 adults during 2001 and 2002. None of the participants had a history of cancer. There were 360 women who were at least 40 years old and 140 men who were at least 50 years old. The survey was restricted to these age groups, Schwartz explained, “because it is at these ages that most cancer screening is recommended, a notable exception being Papanicolaou testing.”

The survey included questions about the value of early detection and four cancer screening tests: Papanicolaou (Pap) smear, mammography, prostate-specific antigen (PSA) test and sigmoidoscopy or colonoscopy.

One screening technology that is often aggressively marketed to consumers is total-body computed tomography (CT) scanning. Although there are no data to support benefit or safety for the test and some medical groups discourage patients from receiving it, 86% of survey participants wanted to have a free total-body CT. When those people were asked if they would prefer a total-body CT scan or $1,000 in cash, 85% would choose the total-body CT. Eighty-seven percent of those surveyed believed that routine cancer screening is “almost always a good idea.” Seventy-four percent believed that finding cancer early saves lives “most” or “all of the time.”

Even if screening detected a cancer for which there was no treatment, 66% of participants wanted to know the cancer was there. Fifty-six percent wanted to know about the existence of cancers that would never cause problems in their lifetime because of the disease’s slow growth. The participants were committed to screening based on their own participation. Almost all women reported a Pap test and 89% had a mammography. Among men, 71% had a PSA test. The rate of colonoscopy or sigmoidoscopy was 46% among men and women.

The commitment to screening was strong enough that many participants “would overrule a physician who recommended against cancer screening and could not imagine a time when they would stop being tested,” Schwartz said. She added that although 38% of participants had at least one false-positive result described by many participants as a scary time in their lives, 98% of these participants were glad they had the original test.

“Our work suggests that screening is not seen as a choice but as an obligation,” Schwartz said. During focus groups, participants said they owed it to their children to be screened and that it would be selfish to refuse cancer screening.
The researchers asked survey participants whether a person in average health would be irresponsible if he or she did not have screening. The percentage of people considering this irresponsible for a 55-year-old ranged from 79% for not having a Pap test to 54% for not having colonoscopy.

When asked about an 80-year-old, the responses ranged from 41% who felt not receiving a mammography would be irresponsible to 32% who felt not receiving a colonoscopy would be irresponsible.