title: Testing for prostate and colorectal cancer: comparison of self-report and medical record audit.
abstract: BACKGROUND
  Self-reported data are often used to determine cancer screening test utilization, but self-report may be inaccurate.
  
  
  METHODS
  We interviewed members of three health maintenance organizations and reviewed their medical records for information on digital rectal exam (DRE), prostate-specific antigen (PSA) test, fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy (response rate 65%). We calculated the sensitivity, specificity, concordance, and kappa statistic to compare the two sources for black men (n = 363), white and other men (n = 847), and women (n = 920) by study location.
  
  
  RESULTS
  For DRE, FOBT, sigmoidoscopy, and colonoscopy, testing rates determined by self-report were higher than those in medical records. Kappa statistics showed fair to good agreement (0.40-0.80) for PSA, sigmoidoscopy, and colonoscopy among most subgroups. For DRE and FOBT, the agreement was poor except among participants from one HMO. Sensitivity was > or = 80% for sigmoidoscopy among most subgroups, and > or = 85% for endoscopy (sigmoidoscopy and colonoscopy), >75% for DRE, and > or = 63% for PSA among all subgroups. Specificity exceeded 80% for FOBT and colonoscopy among all subgroups. Agreement was lower among older age groups. For all tests, agreement was poor between the reasons for testing.
  
  
  CONCLUSIONS
  Overreporting for some cancer tests should be considered when using self-reported data to evaluate progress towards reaching national goals for prevention behaviors.
authors.affiliation: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. ixh1@cdc.gov
authors.forename: H Irene
authors.initials: HI
authors.lastname: Hall
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Van Den Eeden
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Tolsma
authors.forename: Kate
authors.initials: K
authors.lastname: Rardin
authors.forename: Trevor
authors.initials: T
authors.lastname: Thompson
authors.forename: Amber
authors.initials: A
authors.lastname: Hughes Sinclair
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Madlon-Kay
authors.forename: Marion
authors.initials: M
authors.lastname: Nadel
mesh_terms: D000368:Aged; D044383:Black People; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004522:Educational Status; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008499:Medical Records; D008875:Middle Aged; D009780:Occult Blood; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D015203:Reproducibility of Results; D012650:Self Disclosure; D012812:Sigmoidoscopy; D014481:United States; D044465:White People; D001741:Black or African American
chemical_list: D017430:Prostate-Specific Antigen