Chronic
Letter Regarding the Impact of U.S. Preventive Services Task Force Recommendations in Breast Cancer Screening Trends
Dehkordy et al.1 performed an analysis of 4 years of data from the Behavioral Risk Factor Surveillance Survey (BRFSS) comparing screening mammography rates prior to and after the U.S. Preventive Services Task Force’s (USPSTF’s) 2009 revisions to its breast cancer screening guidelines, which withdrew recommendations that women aged 40−49 years have biennial mammograms.2 Dehkordy and colleagues’ analysis finds that mammography screening rates decreased from 2007 to 2012, whereas screening initiation rates at age 40 years increased during that period.Response to Letter Regarding the Impact of U.S. Preventive Services Task Force Recommendations in Breast Cancer Screening Trends
We thank Dr. Levy for his insightful, helpful comments regarding this methodologic change with Behavioral Risk Factor Surveillance Survey weighting from post-stratification to raking. We are grateful for the opportunity to consider how it may have impacted our findings and their interpretation,1,2 and we agree even a minor adjustment to sampling and survey weights can result in differences in estimates, even for small effects. In this case, it may have had little impact on our primary conclusions, given that the shape of trend lines in screening mammography adherence and initiation were relatively stable over time and within-year trends were consistent across 2010 (before the changes) and 2012 (after the changes) (Appendix Figure 1 and Appendix Table 2 in the manuscript present these results in detail).Response to Letter Regarding Indoor Ultraviolet Radiation Tanning and Skin Cancer
We thank Dr. Grant for his letter regarding our article proposing that the Surgeon General declare that indoor ultraviolet (UV) tanning causes skin cancer. We argue that indoor UV light causes skin cancer (melanoma and keratinocyte carcinomas of the skin) and that the Surgeon General should clearly state this now. Further to this point, UV light is classified as a carcinogen by the WHO International Agency for Research on Cancer, U.S. Government National Toxicology Program, and American Cancer Society.Letter Regarding Indoor Ultraviolet Radiation Tanning and Skin Cancer
Karimkhani and colleagues1 called on the Surgeon General to announce that indoor ultraviolet (UV) tanning is causally linked to skin cancer, making the analogy to smoking and lung cancer. Smoking kills hundreds of thousands in the U.S. annually and has no health benefits. Only about 10% of the U.S. population uses tanning devices, so indoor UV tanning cannot be responsible for more than 14% of U.S. deaths per year from cutaneous malignant melanoma (CMM) (834, 95% CI=646, 1,020).2,3Predictors of Human Papillomavirus Awareness and Knowledge in 2013: The Importance of Health Literacy
The recent article by Blake et al.1 highlights the important gaps in awareness and knowledge about human papillomavirus (HPV), its relationship with cancer, and the HPV vaccine in the U.S. population. As noted by the authors, the introduction of a health technology can lead to health inequalities if there is differential learning among population subgroups, the so-called “Knowledge Gap Hypothesis.” Comparisons with previous analyses of the Health Information and National Trends Survey (HINTS) suggest awareness has increased among the U.S.Early Prevention and Screening of Cervical Cancer in a Developing Country
We have read with much interest an article recently published by Ekwueme et al.1 about the impact of the National Breast and Cervical Cancer Early Detection Program on cervical cancer mortality among uninsured low-income women in the U.S. Cervical cancer is a relevant issue in Peru, owing to its high incidence and mortality rate when compared with other countries.2 Despite being a fully preventable cancer with a clearly known pathogen, its early prevention and detection remains a problem in Peru, which is worsened by poverty conditions and inadequate access to health care, as well as unequal distribution of health workers among the country’s different regions.Perceived Ambiguity, Fatalism, and Believing Cancer Is More Prevalent Than Heart Disease
In most subpopulations, heart disease incidence is higher than cancer incidence,1 yet laypeople may think the reverse given extensive cancer exposure2 such as the “pink ribbon” campaign and celebrity deaths (e.g., Peter Jennings3). People often overestimate their own cancer risk4 and thus may also overestimate its relative prevalence. Such misperceptions could promote underuse of preventive interventions for cardiovascular disease and overuse of cancer risk reduction strategies.U.S. Preventive Services Task Force Diabetes Screening
To the Editor: In a recent AJPM article, Casagrande and colleagues1 attempt to make a case for altering the diabetes screening recommendation by the U.S. Preventive Services Task Force (USPSTF) based on the current recommendation’s low sensitivity in detecting previously undetected type 2 diabetes and other cardiovascular disease (CVD) risk factors that have a high prevalence in those with undetected diabetes. Although test sensitivity is one criterion to consider in assessing screening tests, it is not the most important.
