Cancer screening practices of cancer survivors: population-based, longitudinal study

Objective — To describe cancer screening rates for cancer survivors and compare them with those for matched controls.

Design — Population-based, retrospective study with individuals linked across administrative databases.

Setting — Ontario.

Participants — Survivors of breast (n = 11 219), colorectal (n = 4348), or endometrial (n = 3473) cancer, or Hodgkin lymphoma (HL) (n = 2071) matched to general population controls. Survivors were those who had completed primary treatment and were on "well" follow-up. The study period was 4 years (1 to 5 years from the date of cancer diagnosis).

Main Outcome Measures — Never versus ever screened (in the 4-year study period) for breast cancer, colorectal cancer (CRC), and cervical cancer and never versus ever received (during the study period) a periodic health examination; rates were compared between cancer survivors and controls. Random effects models were used to estimate odds ratios and 95% CIs.

Results — Sixty-five percent of breast cancer survivors were never screened for CRC and 40% were never screened for cervical cancer. Approximately 50% of CRC survivors were never screened for breast or cervical cancer. Thirty-two percent of endometrial cancer survivors were never screened for breast cancer and 66% were never screened for CRC. Forty-four percent of HL survivors were never screened for breast cancer, 77% were never screened for CRC, and 32% were never screened for cervical cancer. Comparison with matched controls showed a mixed picture, with breast and endometrial cancer survivors more likely, and CRC and HL survivors less likely, than controls to be screened.

Conclusion — There is concern about the preventive care of cancer survivors despite frequent visits to both oncology specialists and family physicians during the "well" follow-up period.