Study finds patients overestimate cancer screening history

May 15 2008

A new American Cancer Society study finds female African American patients tend to overestimate their level of cancer screening, indicating that current estimates of screening based on self-reported data may be lower than reported.

Researchers from the Society's Behavioral Research Center, led by Barbara D. Powe, PhD, RN, interviewed 116 African American female patients at a federally qualified health center (FQHC) and compared their recollection to the screening history documented in the patients' medical records for four medical tests: clinical breast examination; mammography; Pap testing; and screening with a fecal occult blood test (FOBT). They found the level of incongruence between self-report and medical record documentation was more than 50 percent for some procedures.

Eighty-six percent of the women who were age 20 or older (n = 94) reported having a CBE in their lifetime, 67 percent in the past year, 20 percent in the past two to five years, and 10 percent more than five years ago. Based on medical record documentation, 35 percent of the women had a CBE in their lifetime, 26 percent in the past year, 4 percent in the past two to five years, and 2 percent more than five years ago.

Seventy-seven percent of the women over 40 (n=35) reported ever having a mammogram in their lifetime, 29 percent in the past year, 29 percent in the past two to five years, and 6 percent more than five years ago. Based on documentation in the medical record, 40 percent of the women had a mammogram in their lifetime, 9 percent in the past year, 26 percent in the past two to five years, and 6 percent more than five years ago.

Of the 43 women asked about Pap test use, 96 percent reported having had a Pap test in their lifetime, 72 percent in the past year, 26 percent in the past two to five years, and 12 percent more than five years ago. Based on documentation in the medical record, 58 percent of the women had a Pap test in their lifetime, 39 percent in the past year, 25 percent in the past two to five years, and 13 percent more than five years ago.

Fifty-six percent of the women over 50 (n=16) reported ever having a fecal occult blood test (FOBT) in their lifetime, 35 percent in the past year, 12 percent in the past two to five years, and 6 percent more than five years ago. Based on documentation in the medical record, 11 percent of the women had a FOBT in their lifetime, 12 percent in the past year, and 0 percent in the past two to five years or more than five years ago.

The researchers acknowledge that the women could have received services without documentation in the medical record or that the women could have mistakenly believed a clinical service included screening when it did not. Nevertheless, they cite previous research that also has found patients tend to over-report their level of screening.

The authors say maintaining efforts to effectively monitor and track participation in cancer screening among African Americans and other groups should be a priority, offering the electronic medical record as one way to ensure more accurate medical documentation. "Self-reported screening rates are the foundation for many policy decisions that have a significant influence on the availability of resources for this population," said Dr. Powe. "Indeed, over- or underestimation of screening can be even more significant for African Americans, who bear a disproportionate cancer burden."

Article: Oncology Nursing Forum, March 2008, pp. 199-204.