[Skip to Content]
[Skip to Content Landing]
Article
May 23, 1994

Self-reported Use of Cancer Screening Tests Among Latinos and Anglos in a Prepaid Health Plan

Author Affiliations

From the Division of General Internal Medicine, Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, University of California—San Francisco (Drs Pérez-Stable, Otero-Sabogal, Sabogal, and McPhee) and Division of Research, Kaiser Permanente Medical Care Program, Oakland, Calif (Dr Hiatt).

Arch Intern Med. 1994;154(10):1073-1081. doi:10.1001/archinte.1994.00420100041007
Abstract

Objective:  To evaluate self-reported use of cancer screening tests by Latino and Anglo prepaid health plan members, we conducted telephone interviews about the knowledge of, use of, and reason for Papanicolaou (Pap) smear, clinical breast examination, mammogram, rectal examination, fecal occult blood test, and sigmoidoscopy.

Methods:  Cross-sectional telephone survey of randomly selected Kaiser Permanente Medical Care Program members in San Francisco and Alameda Counties, California. A total of 844 Latinos (432 men and 412 women) and 510 Anglos (208 men and 302 women), between 35 and 74 years of age, completed the interview.

Results:  Overall, 97.4% of Latinas reported having had at least one Pap smear compared with 99.7% of Anglo women; 90% in each group reported a Pap smear within 3 years. A clinical breast examination within 2 years was reported by 87% of Latina and 90% of Anglo women. Seventy-six percent of Latina and 85% of Anglo women aged 35 years or more reported having had at least one mammogram; and 65% of Latina and 75% of Anglo women reported a mammogram within 2 years. Among members 40 to 74 years of age, a lower proportion of Latinos compared with Anglos reported having had at least one digital rectal examination (67% vs 80%) and one fecal occult blood test (46% vs 54%); among those 50 to 74 years of age, fewer Latinos reported at least one sigmoidoscopy (29% vs 41%). After adjusting for age, education, employment, perceived health status, marital status, and county of residence, Latinos were significantly less likely to report having had at least one digital rectal examination (odds ratio; 0.60,95% confidence interval, 0.45,0.79), fecal occult blood test (odds ratio, 0.77; 95% confidence interval, 0.59-1.01), and sigmoidoscopy (odds ratio, 0.70; 95% confidence interval, 0.52,0.95). After adjusting for the same variables, Latinos were more likely than Anglos to claim forgetfulness/carelessness (75% vs 60%; odds ratio, 1.84; 95% confidence interval, 1.41-2.40) as a reason for not obtaining cancer screening tests.

Conclusion:  These data suggest that, within this prepaid health plan without direct financial barriers to cancer screening services, Latinos are less likely than Anglos to obtain selected recommended cancer screening tests.(Arch Intern Med. 1994;154:1073-1081)

References
1.
Bureau of the Census, Economics and Statistics Administration. Race and Hispanic Origin: 1990 Census Data . Washington, DC: US Dept of Commerce; 1991.
2.
Maurer JD, Rosenberg HM, Keemer JB.  Deaths of Hispanic origin, 15 reporting States, 1979-1981: National Center for Health Statistics . Vital Health Stat. 1990; 20:1-73.
3.
Rosenwaike I.  Mortality differentials among persons born in Cuba, Mexico, and Puerto Rico residing in the United States, 1979-81 . Am J Public Health . 1987; 77:603-606.Article
4.
National Cancer Institute. Cancer Among Blacks and Other Minorities: Statistical Profiles . Washington, DC: US Dept of Health and Human Services, Public Health Service; 1986. NIH Publication No. 86-2785.
5.
Marcus AC, Crane LA.  Smoking behavior among US Latinos: an emerging challenge for public health . Am J Public Health. 1985;75:169-172.Article
6.
Marin G, Pérez-Stable EJ, Marín BV.  Cigarette smoking among San Francisco Hispanics: the role of acculturation and gender . Am J Public Health. 1989;79: 196-198.Article
7.
Haffner SM, Knapp JA, Hazuda HP, Stern MP, Young EA.  Dietary intakes of macronutrients among Mexican Americans and Anglo Americans: the San Antonio heart study . Am J Clin Nutr. 1985;42:1266-1275.
8.
Elder JP, Castro FG, de Moor C, et al.  Differences in cancer risk—related behaviors in Latino and Anglo adults . Prev Med. 1991;20:751-763.Article
9.
Zunzunegui MV, King MC, Coria CF, Charlet J.  Male influences on cervical cancer risk . Am J Epidemiol. 1986;123:302-307.
10.
Marin G, Marín BV. Research With Hispanic Populations . Newbury Park, Calif: Sage Publications; 1991:130.
11.
Lecca PJ, Greenstein TN, McNeil JS. A Profile of Mexican American Health: Data From the Hispanic Health and Nutrition Examination Survey 1982-84 . Arlington, Tex: Health Services Research; 1987:1-93.
12.
Harlan LC, Bernstein AB, Kessler LG.  Cervical cancer screening: who is not screened and why? Am J Public Health. 1991;81:885-890.Article
13.
Gorelic LS, Dresser C, Weed D, Graubard B, Ruiz E. Cervical Cancer Screening Practices by Hispanic Women. Seattle, Wash: American Society of Preventive Oncology; 1991.
14.
Kirkman-Liff B, Kronenfeld JJ.  Access to cancer screening services for women . Am J Public Health. 1992;82:733-735.Article
15.
Krieger N.  Overcoming the absence of social class data in medical records: a validation and application of a census-based methodology . Am J Public Health. 1992;82:703-710.Article
16.
Bureau of the Census. 1980 Census of Population and Housing: Spanish Surname List Technical Documentation . Washington, DC: US Bureau of the Census, Data User Services Division; 1980.
17.
Brislin RW, Lonner WJ, Thorndike EM. Cross-Cultural Research Methods . New York, NY: John Wiley & Sons Inc; 1973.
18.
National Cancer Institute. Working Guidelines for Early Detection: Rationale and Supporting Evidence to Decrease Mortality . Bethesda, Md: National Cancer Institute; 1987.
19.
Marin G, Sabogal F, Marin BV, Otero-Sabogal R, Pérez-Stable EJ.  Development of a short acculturation scale for Hispanics . Hisp J Behav Sci. 1987;9:183-205.Article
20.
Pérez-Stable EJ, Sabogal F, Otero-Sabogal R, Hiatt RA, McPhee SJ.  Misconceptions about cancer among Latinos and Anglos . JAMA. 1992;268:3219-3223.Article
21.
SPSSX. User's Guide . 2nd ed. Chicago, III: SPSS; 1986.
22.
Ott L. An Introduction to Statistical Methods and Data Analysis . Boston, Mass: PWS-Kent Publishing Co; 1988:220.
23.
Simon R.  Confidence intervals for reporting results of clinical trials . Ann Intern Med. 1986;105:429-435.Article
24.
Wenneker MB, Epstein AM.  Racial inequalities in the use of procedures for patients with ischemic heart disease in Massachusetts . JAMA. 1989;261:253-257.Article
25.
Strogatz DS.  Use of medical care for chest pain: differences between blacks and whites . Am J Public Health. 1990;80:290-294.Article
26.
Hannan EL, Kilburn H, O'Donnell JF, Lukacik G, Shields EP.  Interracial access to selected cardiac procedures for patients hospitalized with coronary artery disease in New York State . Med Care. 1991;29:430-441.Article
27.
Farrow DC, Hunt WC, Samet JM.  Geographic variation in the treatment of localized breast cancer . N Engl J Med. 1992;326:1097-1101.Article
28.
McPhee SJ, Jenkins CNH, Hung S, et al.  Behavioral risk factor survey of Vietnamese: California, 1991 . MMWR Morb Mortal Wkly Rep. 1992;41:69-72.
29.
Ackermann SP, Brackbill RM, Bewerse BA, Cheal NE, Sanderson LM.  Cancer screening behaviors among US women: breast cancer, 1987-1989, and cervical cancer, 1988-1989 . In: CDC Surveillance Summaries. MMWR Morb Mortal Wkly Rep. 1992;41(No. (SS-2) ):17-34.
30.
Shapiro S.  Evidence on screening for breast cancer from a randomized trial . Cancer. 1977;39:2772-2782.Article
31.
Guzick DS.  Efficacy of screening for cervical cancer: a review . Am J Public Health. 1978;68:125-134.Article
32.
Gilbertsen VA, McHugh R, Schuman L, McHugh R, Schuman L, Williams SE.  The earlier detection of colorectal cancers: a preliminary report of the results of the occult blood study . Cancer. 1980;45:2899-2901.Article
33.
Selby JV, Friedman GD, Quesenberry CP, Weiss NS.  A case-control study of screening sigmoidoscopy and mortality from colorectal cancer . N Engl J Med. 1992;326:653-657.Article
34.
Centers for Disease Control.  Hysterectomy prevalence and death rates for cervical cancer: United States, 1965-1988 . MMWR Morb Mortal Wkly Rep. 1992; 41:17-20.
35.
California Department of Health Services.  Racial and ethnic variation in the use of selected cancer prevention services among California women, 1987-1990 . Calif Morb. 1991;51-52.
36.
Vernon SW, Vogel VG, Halabi S, Jackson GL, Lundy RO, Peters GN.  Breast cancer screening behaviors and attitudes in three racial/ethnic groups . Cancer. 1992;69:165-174.Article
37.
Zapka JG, Hosmer D, Costanza ME, Harris DR, Stoddard A.  Changes in mammography use: economic, need, and service factors . Am J Public Health. 1992; 82:1345-1351.Article
38.
Hiatt RA, Tekawa IS.  Mammography utilization in relation to stage at diagnosis for breast cancer: the Kaiser Permanente experience in a large pre-paid health plan . Adv Cancer Control. 1990;1:227-238.
39.
Bastani R, Marcus AC, Hollatz-Brown A.  Screening mammography rates and barriers to use: a Los Angeles County survey . Prev Med. 1991;20:350-363.Article
40.
Stein JA, Fox SA.  Language preference as an indicator of mammography use among Hispanic women . J Natl Cancer Inst. 1990;82:1715-1716.Article
41.
Mandel JS, Bond JH, Church TR, et al.  Reducing mortality from colorectal cancer by screening for fecal occult blood . N Engl J Med. 1993;328:1365-1371.Article
42.
Pérez-Stable EJ.  Issues in Latino health care medical staff conference . West J Med. 1987;146:213-218.
43.
Sandoval MC, de la Roza MC.  A cultural perspective for serving the Hispanic client . In: Pedersen HPL, ed. Cross-Cultural Training for Mental Health Professionals . Springfield, III: Charles C Thomas Publisher; 1991.
44.
McPhee SJ, Bird JA, Fordham D, Rodnick JE, Osborn EH.  Promoting cancer prevention activities by primary care physicians . JAMA. 1991;266:538-544.Article
45.
Walsh JME, McPhee SJ.  A systems model of clinical preventive care: an analysis of factors influencing patients and physicians . Health Educ Q. 1992;19: 157-175.Article
46.
McKenna MT, Speers M, Mallin K, Warnecke R.  Agreement between patient self-reports and medical records for pap smear histories . Am J Prev Med. 1992; 8:287-291.
47.
Gordon NP, Hiatt RA, Lampert DI.  Concordance of self-reported data and medical record audit for six cancer screening procedures . J Natl Cancer Inst. 1993; 85:566-570.Article
×