title: Associations of race, education, and patterns of preventive service use with stage of cancer at time of diagnosis.
abstract: OBJECTIVE
  To go beyond the documentation of disparities by race and SES by analyzing health behaviors regarding preventive and cancer screening services and determining if these behaviors are associated with stage of cancer when first diagnosed.
  
  
  METHODS
  Stage of cancer for Medicare patients diagnosed in 1995 with breast, colorectal, uterine, ovarian, prostate, bladder, or stomach cancer; and use of influenza and pneumonia immunization, mammography, pap smear, colon cancer screening, and the prostate specific antigen test during the two years preceding diagnosis of cancer.
  
  
  METHODS
  Hypothesis tested: health behaviors regarding use of preventive and cancer screening services are associated with stage of cancer when first diagnosed.
  
  
  METHODS
  Information was extracted from the database formed by the linkage of Surveillance, Epidemiology, and End Results (SEER) cancer registries with Medicare files.
  
  
  RESULTS
  Black and white patients (of higher and lower SES) who used more of the preventive and cancer screening services were at a lower risk of having late stage cancer for six cancers studied (breast, colorectal [male and female], prostate, uterine, and male bladder cancer) than their counterparts who used fewer of these services.
  
  
  CONCLUSIONS
  The use of preventive and cancer screening services is a health behavior associated with better health outcomes for the elderly diagnosed with cancer. The lack of preventive service use can serve as a marker for identifying persons at risk of late stage cancer when first diagnosed. Strategies that encourage the use of preventive services by low users of these services are likely to reinforce a range of healthy behaviors that help to ameliorate disparities in health outcomes.
authors.affiliation: Kidney and Urology Epidemiology, National Institute for Diabetes, Digestive, and Kidney Disease, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Marian E
authors.initials: ME
authors.lastname: Gornick
authors.forename: Paul W
authors.initials: PW
authors.lastname: Eggers
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Riley
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009369:Neoplasms / Q000208:ethnology / Q000473:pathology / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data