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The Relationship Between Health Literacy and Nonrecommended Cancer Screening

  • Madeline C. Rutan
    Affiliations
    Division of Urology, Maine Medical Center, Portland, Maine

    Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine

    Tufts University School of Medicine, Boston, Massachusetts
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  • Jesse D. Sammon
    Affiliations
    Division of Urology, Maine Medical Center, Portland, Maine

    Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine

    Tufts University School of Medicine, Boston, Massachusetts
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  • David-Dan Nguyen
    Affiliations
    Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

    Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts

    Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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  • Kerry L. Kilbridge
    Affiliations
    Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
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  • Peter Herzog
    Affiliations
    Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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  • Quoc-Dien Trinh
    Correspondence
    Address correspondence to: Quoc-Dien Trinh, MD, Division of Urological Surgery, Brigham and Women's Hospital, 45 Francis Street, ASB II–3, Boston MA 02115.
    Affiliations
    Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

    Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Published:December 17, 2020DOI:https://doi.org/10.1016/j.amepre.2020.08.018

      Introduction

      Health literacy affects how patients behave within the healthcare system. Overutilization of screening procedures inconsistent with the U.S. Preventive Services Task Force guidelines contributes to the high cost of health care. The authors hypothesize that higher health literacy supports guideline-concordant screening. This study assesses the effect of health literacy on nonrecommended prostate, breast, and cervical cancer screening in patients older than the recommended screening age limit.

      Methods

      The 2016 Behavioral Risk Factor Surveillance System included health literacy modules. Respondents self-reported their ability to obtain and understand health information, resulting in 4 health literacy rankings. The authors calculated the population-weighted proportion of respondents in each health literacy category who underwent screening past the Task Force‒recommended age limit. The ORs of nonrecommended screening for each malignancy were calculated, with low health literacy as the ref category.

      Results

      Individuals with higher health literacy underwent more nonrecommended screening. Nonrecommended prostate cancer screening was performed in 27.4% (95% CI=23.7%, 31.4%) and 47.7% (95% CI=44.1%, 51.3%) of respondents with low and high health literacy, respectively (p<0.001). Nonrecommended breast cancer screening was performed in 46.8% (95% CI=42.6%, 51.1%) and 67.7% (95% CI=64.2%, 71.1%) of respondents with low and high health literacy, respectively (p=0.002). Nonrecommended cervical cancer screening was performed in 33.8% (95% CI=31.1%, 36.5%) and 48.4% (95% CI=46.3%, 50.5%) of respondents with low and high health literacy, respectively (p<0.001). Individuals with high health literacy were significantly more likely than those with low health literacy to screen against the recommendations for prostate (OR=1.73, 95% CI=1.34, 2.23, p<0.001), cervical (OR=1.533, 95% CI=1.31, 1.80, p<0.001), and breast (OR=8.213, 95% CI=4.90, 13.76, p<0.001) cancer.

      Conclusions

      Higher health literacy correlates with increased rates of screening beyond the recommended age, contrary to the study hypothesis. Breast cancer demonstrated the highest rates of nonrecommended screening.
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      REFERENCES

      1. Behavioral Risk Factor Surveillance System: 2016 BRFSS survey data and documentation. Centers for Disease Control and Prevention. https://www.cdc.gov/brfss/annual_data/annual_2016.html. Updated February 20, 2019. Accessed September 15, 2020.

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      2. Recommendations search results. U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/BrowseRec/Index. Updated May 8, 2018. Accessed June 17, 2019.

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