title: Geographically-based cancer control: methods for targeting and evaluating the impact of screening interventions on defined populations.
abstract: Successful implementation of cancer control programs depends on efficient targeting to those at highest risk of developing and dying from the disease. This study presents a methodology for targeting cancer screening on the basis of population and disease variation among small geographic areas. Techniques for quantifying the impact of targeting on the predictive value of a positive test are demonstrated, using 329 New York City health areas. Age-truncated crude incidence, late-stage incidence and mortality rates for breast, cervix, and colorectal cancer are used, using site-specific truncation points relevant to the age groups appropriate for screening. Coefficient alpha was used to determine rate stability with 2, 3, 5 and 7 years of data. The stability of most small area rates was found to reach acceptable levels only with 5 and 7 years of data. Targeting into areas where breast cancer prevalence was high increased the expected predictive value of a positive test by as much as 50% when compared with areas of average prevalence. Geographic targeting will be most useful where between-area variability in prevalence is large and within-area variability is small. The implications of these results are discussed and future studies are suggested.
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
authors.forename: J F
authors.initials: JF
authors.lastname: Kerner
authors.forename: H
authors.initials: H
authors.lastname: Andrews
authors.forename: A
authors.initials: A
authors.lastname: Zauber
authors.forename: E
authors.initials: E
authors.lastname: Struening
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D003110:Colonic Neoplasms / Q000453:epidemiology / Q000401:mortality; D003153:Community Health Services; D004812:Epidemiologic Methods; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D009519:New York City; D011237:Predictive Value of Tests; D012004:Rectal Neoplasms / Q000453:epidemiology / Q000401:mortality; D012307:Risk Factors; D013223:Statistics as Topic; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000401:mortality