Showing papers by "Steven S. Coughlin published in 2004"

Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults

Abstract: Several studies have suggested that diabetes mellitus may alter the risk of developing a variety of cancers, and the associations are biologically plausible. To learn more about the relation between diabetes and cancer mortality, the authors examined associations with selected cancers in a large, prospective US cohort of 467,922 men and 588,321 women who had no reported history of cancer at enrollment in 1982. After 16 years of mortality follow-up, diabetes was significantly associated with fatal colon cancer in men (multivariate relative risk (RR) = 1.20, 95% confidence interval (CI): 1.06, 1.37) and women (RR = 1.24, 95% CI: 1.07, 1.43) and with pancreatic cancer in men (RR = 1.48, 95% CI: 1.27, 1.73) and women (RR = 1.44, 95% CI: 1.21, 1.72). For men, diabetes was significantly associated with liver cancer (RR = 2.19, 95% CI: 1.76, 2.72) and bladder cancer (RR = 1.43, 95% CI: 1.14, 1.80). In addition, diabetes was significantly associated with breast cancer in women (RR = 1.27, 95% CI: 1.11, 1.45). These associations were not explained by high body mass. Our findings suggest that diabetes is an independent predictor of mortality from cancer of the colon, pancreas, female breast, and, in men, of the liver and bladder.

Colorectal Cancer Screening Practices Among Men and Women in Rural and Nonrural Areas of the United States, 1999

Abstract: Background Previous studies have suggested that men and women in rural areas are less likely than those in urban areas to receive routine cancer screening. Methods We examined the colorectal cancer screening practices of men (n = 23,565) and women (n = 37,847) aged > or = 50 years living in rural areas and other areas of the United States using data from the 1999 Behavioral Risk Factor Surveillance System (BRFSS). Geographic areas of residence were classified as rural areas and small towns, suburban areas and small metropolitan areas, and larger metropolitan areas using US Department of Agriculture (USDA) urban/rural continuum codes. Results The estimated median response rate across states was 55.2%. Approximately 16.2% (95% confidence interval [CI] = 15.3% to 17.2%) of persons aged > or = 50 years who resided in rural areas had received a fecal occult blood test in the past year, compared with 22.0% of those living in the larger metropolitan areas (95% CI = 21.4% to 22.7%). About 28.2% (95% CI = 27.1% to 29.4%) of those who resided in rural areas had received a sigmoidoscopy or colonoscopy in the past 5 years, compared with 35.2% of those in the larger metropolitan areas (95% CI = 34.5% to 36.0%). Conclusions These results underscore the need for continued efforts to increase colorectal cancer screening in the United States. Special efforts may be required to increase screening in rural areas.

Breast cancer screening practices among women in the United States, 2000.

Abstract: Results from recent studies indicate that many women in the US undergo routine screening for breast cancer, but some groups of women are under-screened. In this study, we examined the breast cancer screening practices of white and black women in the United States, according to Hispanic ethnicity and other factors, using data from the 2000 National Health Interview Survey. Among women aged ≥40 years, 71.2% (95% confidence interval, CI: 70.0–72.4%) of the 8201 white women and 67.6% (95% CI: 64.5–70.6%) of the 1474 black women in this sample reported having a mammogram in the past two years. About 60.3% (95% CI: 56.7–70.3%) of 970 Hispanic women (including those who reported they were white or black) and 71.5% (95% CI: 70.3–72.7%) of 8705 non-Hispanic women reported having a mammogram in the past two years. About 74.8% (95% CI: 73.8–76.8%) of 8176 white women and 73.8% (95% CI: 71.1–76.6%) of 1471 black women aged ≥40 years had received a clinical breast examination in the past two years. About 60.1% (95% CI: 56.1–64.0%) of 969 Hispanic women (including those who reported they were white or black) and 75.6% (95% CI: 74.6–76.6%) of 8678 non-Hispanic women had received a clinical breast examination in the past two years. Women with lower incomes, those with less education, and recent immigrants were less likely to be screened. Women who had a usual source of health care and those with health insurance coverage were more likely to have been screened. These results underscore the need for continued efforts to ensure that uninsured women and those who are medically underserved have access to cancer screening services.

Nonadherence to breast and cervical cancer screening: What are the linkages to chronic disease risk?

Abstract: Background Several preventive practices that reduce chronic disease risk have been associated with breast and cervical cancer screening, including maintenance of normal weight and avoidance of cigarette smoking. A history of certain chronic illnesses such as diabetes and cardiovascular disease has also been related to cancer screening. Nevertheless, studies that have attempted to identify women who are less likely to have had a recent breast or cervical cancer screening test have infrequently examined the associations of breast and cervical cancer screening with multiple health factors that influence chronic disease risk. Methods To clarify relationships between cancer screening and health behaviors and other factors that influence chronic disease risk, we examined the self-reported breast and cervical cancer screening practices of women in the United States by using data from the 1999 Behavioral Risk Factor Surveillance System. The women were described according to their recent use of mammography and the Papanicolaou test, physician visits within the past year, health insurance coverage, and preventive practices that reduce chronic disease risk. Results Overall, 74.5% (95% CI, 73.9%-75.1%) of the women in this sample aged 40 years or older (n = 56,528) had received a mammogram within the past 2 years. The percentage of women who had been screened for breast cancer, however, varied widely by factors associated with reducing the risk of chronic disease (e.g., cholesterol check in the past 2 years, blood pressure check in the past 2 years, normal weight, avoidance of cigarette smoking) and having access to health care (e.g., health insurance coverage, recent physician visit). Similarly, 84.4% (95% CI, 83.9%-84.9%) of all women aged 18 years or older who had not undergone a hysterectomy (n = 69,113) had received a Papanicolaou test in the past 3 years, and factors associated with reduced chronic disease risk and health care access were related to having had a recent Papanicolaou test. Conclusion The results of this study suggest that underscreened women who are at risk for breast and cervical cancer are likely to benefit from programs that identify and address coexisting prevention needs. The identification of coexisting prevention needs might assist in developing interventions that address multiple risks for chronic disease among women and might subsequently help improve the efficiency and effectiveness of prevention programs.

The Cancer Prevention and Control Research Network

Abstract: The Cancer Prevention and Control Research Network is a national network recently established to focus on developing new interventions and disseminating and translating proven interventions into practice to reduce cancer burden and disparities, especially among minority and medically underserved populations. Jointly funded by the Centers for Disease Control and Prevention and the National Cancer Institute, the Cancer Prevention and Control Research Network consists of sites administered through Prevention Research Centers funded by the Centers for Disease Control and Prevention. The five sites are located in Kentucky, Massachusetts, South Carolina, Texas, Washington State, and West Virginia. The Cancer Prevention and Control Research Network's intervention areas include primary prevention of cancer through healthy eating, physical activity, sun avoidance, tobacco control, and early detection of cancer through screening. The Cancer Prevention and Control Research Network uses the methods of community-based participatory research and seeks to build on the cancer-relevant sys- tematic reviews of the Guide to Community Preventive Services. Initial foci for the Cancer Prevention and Control Research Network's research work groups include projects to increase screening for breast, cervical, and colorectal cancers; to promote informed decision making for prostate cancer screening; and to validate educational materials developed for low-literacy populations.

Colorectal carcinoma mortality among Appalachian men and women, 1969-1999.

Abstract: BACKGROUND Colorectal carcinoma screening can reduce mortality, but residents of poor or medically underserved areas may face barriers to screening. The current study assessed colorectal carcinoma mortality in Appalachia, a historically underserved area, from 1969 to 1999. METHODS All counties within the 13-state Appalachian region, which stretches from southern New York to northern Mississippi, were used to calculate annual death rates for the 31-year period. Joinpoint regression analysis was used to examine trends by age and race for the Appalachian region and the remainder of the United States. Five-year rates for 1995–1999 age-adjusted to the 2000 U.S. standard population were calculated by race and age group for the Appalachian region and elsewhere in the United States. RESULTS Trend analysis showed that colorectal carcinoma death rates among both racial and gender groups studied had declined in recent years. Despite this, the rates for white males and white females were still significantly higher in Appalachia than in the rest of the country at the end of the study period, 1999. Five-year colorectal carcinoma death rates among white males (ages < 50, 50–59, and 70–79 years) and white females (ages < 50, 50–59, 70–79, ≥ 80 years) were significantly higher in Appalachia than elsewhere in the United States, whereas rates among black females 60–69 and 70–79 years old were significantly lower in Appalachia. CONCLUSIONS The Appalachian region may benefit from targeted prevention efforts to eliminate disparities in the colorectal carcinoma death rates among subgroups. Further studies are needed to determine whether the higher death rates in specific Appalachian subgroups are related to a higher incidence of the disease, the cancer being at a later stage at diagnosis, poorer treatment, or other factors. Cancer 2004. Published 2004 by the American Cancer Society.

Breast and cervical cancer screening among Mississippi Delta women.

Abstract: The purpose of the study was to determine breast and cervical cancer screening among women living in the Mississippi Delta region. Using data from the Behavioral Risk Factor Surveillance System for 1999-2000, we determined the prevalence of mammography (women 40 years and older, n = 6,028) and Pap testing (women 18 years and older, n = 6,502) within the past 2 or 3 years, respectively. We examined predictors of testing and compared results with those for women living elsewhere in the United States. Among Delta women, 69.4% (95% confidence interval [CI] 67.9% to 70.9%) had a mammogram and 85.5% (95% CI 84.3% to 86.6%) a Pap test. Mammography prevalence was lower among black and white Delta women than among black and white women elsewhere. Pap testing was lower among older (65 years and older) Delta women or women who did not visit a doctor within the past year than among their counterparts elsewhere. Additional interventions are needed to meet the goals of Healthy People 2010 for all women.

Breast and cervical cancer mortality in the Mississippi Delta, 1979-1998.

Abstract: Background: Historically, the Mississippi Delta region has been medically underserved. This may lead to lower cancer prevention efforts and higher breast or cervical cancer mortality rates. Methods: Death rates for 1979 through 1998 were calculated for Mississippi Delta women and for women living elsewhere in the US. Results: Breast cancer mortality in the Delta was similar to that elsewhere in the US in recent years for both black and white women, but rates were lower in the Delta in the early years of the study period. Overall, cervical cancer mortality was similar in the two areas but rates declined more rapidly elsewhere in the US than in the Delta. Breast and cervical cancer mortality was higher among black women than among white women in both areas. Cervical cancer mortality was higher among white rural and black urban women in the Delta than their counterparts elsewhere. Conclusion: These results can guide prevention activities for reducing mortality from these diseases.