Cancer Screening Offered by Worksites -- United States, 1992 and 1995

Since the early 1970s, many U.S. businesses have implemented worksite health promotion programs to help contain employer health-care costs; improve employees' health status, productivity, and morale; reduce absenteeism and employee turnover; and provide a convenient setting for screening and education. Because approximately 130 million persons in the United States work, the worksite is an effective location for offering health screening and educational programs otherwise unaccessible to at-risk persons (1,2). From the late 1980s to the early 1990s, the prevalence of worksite health promotion activities increased in the United States (3). To characterize more recent national practices in worksite-based cancer screening programs, CDC examined data from two national probability surveys -- the Office of Disease Prevention and Health Promotion's (ODPHP's) 1992 National Worksite Health Promotion Survey and CDC's 1995 Worksite Benchmark Survey (4,5). This report summarizes the results of the analysis, which indicate that, in contrast to previous findings about worksite health promotion in the 1980s, the prevalence of worksites offering cancer screening declined from 1992 to 1995.

The 1992 ODPHP survey was designed to measure worksite health promotion activities, policies, screening programs, and educational efforts in 14 program areas. In 1995, CDC implemented the Benchmark Survey, designed to provide prevalence measures of worksites' philanthropy, policies, and practices related to acquired immunodeficiency syndrome and compare them with eight other health topics. The Benchmark Survey also included selected questions from the ODPHP survey to measure changes since 1992. Both surveys measured the prevalence of worksite screening programs for colorectal, skin, cervical, oral, and breast cancers. The 1995 survey also asked about prostate cancer screening.

The sampling frame for both surveys was a list obtained from commercial vendors of all U.S. private-sector worksites with greater than or equal to 50 employees (4,5). Stratified random samples of 1507 (1992) and 1720 (1995) worksites for the respective surveys were selected to represent four size strata and six standard industry types. Both surveys used computer-assisted telephone interviews of directors of health promotion or human resources. The response rate among eligible worksites sampled was 74% for the 1992 survey and 78% for the 1995 survey (4,5). Estimates of prevalence rates for the 1992 survey were obtained from the survey's technical report (4). Weighted estimates and their associated sampling variances for the 1995 survey were computed using SUDAAN. From 1992 to 1995, changes of greater than or equal to 7% for worksites offering cancer screening and greater than or equal to 12% for worksites offering specific cancer screenings were detectable at the 0.05 (two-tailed) level with 80% power.

The overall proportion of worksites offering cancer screening decreased significantly from 1992 (12.0%; 95% confidence interval {CI}=plus or minus 2.0%) to 1995 (6.5%; 95% CI=plus or minus 2.6%), with significant interactions by size and type of worksite (Table_1). Decreases occurred in three of the four size strata (range: 8.2%-22.5%), but not in the smallest worksites. Despite significant decreases, the prevalence of worksites offering screening increased directly with the number of employees at the worksite. Stratification by industry type indicated substantial decreases in the prevalence of cancer screening programs offered by the agriculture/mining/construction (7.5%), wholesale/retail (7.6%), and transportation/public utilities (7.5%) industries. In comparison, the prevalences of programs offered by finance/insurance/real estate, manufacturing, and service industries were unchanged.

Of the worksites offering cancer screenings, breast cancer screening was the most common test offered in both 1992 and 1995 (Table_2). The proportion of worksites providing colorectal and oral cancer screenings decreased substantially from 1992 to 1995, and the proportion of worksites offering screening for breast and cervical cancers was unchanged. Screening for prostate cancer was not directly assessed by the 1992 survey; however, prostate cancer screening was the second most frequently offered screening service in 1995.

Reported by: V Iannacchione, MS, Research Triangle Institute, Research Triangle Park, North Carolina. Office of the Director, and Program Svcs Br, Div of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that substantially fewer U.S. worksites offered cancer screening in 1995 than in 1992. Potential reasons for this decrease include recent trends in corporate downsizing; employers' uncertainty regarding the effectiveness of worksite screening programs; and employers' perceptions of on-site screenings as duplicating services available elsewhere. In addition, employers may recognize the need for screening services to include appropriate links to the health-care delivery system to ensure that employees receive appropriate diagnostic follow-up, but such comprehensive services can be costly (6).

Advantages of worksite screening programs include decreasing health-care costs by early detection and treatment of disease and reducing the barriers of time, cost, and inconvenience (2). However, the efficacy of worksite-based screening programs has not been conclusively established, and benefits have focused primarily on mammography (7).

The findings in this report are subject to at least three limitations. First, overall objectives and contexts of the two surveys differed; however, individual questions were similar or identical. Second, some survey questions about specific cancer screening programs may have required knowledge not available to some respondents, possibly introducing measurement bias. Finally, because only 12% of worksites in 1992 and 6% in 1995 offered cancer screening programs, estimates of the specific types of cancer screenings offered were associated with wide confidence intervals.

In addition to confirming the findings in this report, priorities for assessment include determining the reasons for the decrease and assessing the efficacy of worksite programs. Employers should consider offering screening services if they have been proven effective. If the screening test is effective but the efficacy of offering the test at the worksite is unknown, employers can be influential in encouraging screening, even if they do not offer the service onsite. To provide comprehensive screening services for their employees, employers should consider promoting and offering screening and ensuring that insurance carriers and managed-care plans cover and actively promote screening programs.

References

1. O'Donnell MP, Ainsworth TH. Health promotion in the workplace. New York: John Wiley and Sons, 1984.

2. Warner KE. Wellness at the worksite. Health Aff 1990;9:63-79.

3. Public Health Service, US Department of Health and Human Services. 1992 National Survey of Worksite Health Promotion Activities: summary. Am J Health Promotion 1993;7:452-64.

4. Public Health Service, US Department of Health and Human Services. 1992 National Survey of Worksite Health Promotion Activities: final report. Reproduced by the US Department of Commerce, National Technical Information Service, 1992; report no. PB93-100204.

5. US Department of Health and Human Services. Business Responds to AIDS Benchmark Survey: technical report. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1996.

6. Stokols D, Pelletier KR, Fielding JE. The ecology of work and health: research and policy directions for the promotion of employee health. Health Educ Q 1996;23:137-58.

7. Eley JW. Analyzing costs and benefits of mammography screening in the workplace. AAOHN J 1989;37:171-7.

   
   
   
   Table_1
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   TABLE 1. Percentage of worksites offering cancer screenings, by size and industry type
   -- United States, 1992 and 1995
   =============================================================================================================================
                                                                 1992                       1995
                                                               (n=1507)                   (n=1720)                  % Change
                                                         --------------------        -------------------              from
   Size/Industry                                           %       (95% CI *)         %        (95% CI)           1992 to 1995
   ---------------------------------------------------------------------------------------------------------------------------
   Size of worksite
      50- 99 employees                                    6.2      (+/-2.3%)          4.4     (+/- 4.2%)                --
     100-249 employees                                   13.4      (+/-3.3%)          5.2     (+/- 2.7%)             - 8.2 +
     250-749 employees                                   22.7      (+/-5.1%)         10.3     (+/- 4.0%)             -12.5 +
       >=750 employees                                   57.5      (+/-8.0%)         35.2     (+/-10.9%)             -22.5 &
   
   Type of industry
     Agriculture/Mining/Construction                      9.5      (+/-5.0%)          2.0     (+/- 1.8%)             - 7.5 &
     Manufacturing                                       10.1      (+/-3.2%)          7.6     (+/- 8.1%)                --
     Transportation/Communications/Utilities             15.8      (+/-6.7%)          7.5     (+/- 4.6%)             - 7.5 @
     Wholesale/Retail                                     9.0      (+/-3.6%)          1.4     (+/- 1.2%)             - 7.6 +
     Finance/Insurance/Real estate                       12.1      (+/-6.5%)          5.8     (+/- 3.9%)                --
     Services                                            14.9      (+/-4.3%)         11.3     (+/- 5.6%)                --
   
   Total                                                 12.0      (+/-2.0%)          6.5     (+/- 2.6%)              -- **
   ---------------------------------------------------------------------------------------------------------------------------
    * Confidence interval.
    + p<0.001.
    & p<0.01.
    @ p<0.05.
   ** Overall test not reported because of interactions by size and type of worksite.
   =============================================================================================================================
   

   
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   Table_2
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   TABLE 2. Percentage of cancer screenings offered in worksites reporting at least one
   type of cancer screening, by type of cancer -- United States, 1992 and 1995
   =========================================================================================
                                 1992                      1995
                               (n=181)                    (n=215)
                         --------------------      --------------------      % Change from
   Type of cancer         %        (95% CI *)       %         (95% CI)        1992 to 1995
   ---------------------------------------------------------------------------------------
   Breast                62.5      (+/-8.6%)       58.9      (+/-17.8%)           --
   Prostate              NA +         --           29.2      (+/-14.2%)           --
   Colorectal            55.0      (+/-8.9%)       25.0      (+/-12.9%)         -30.0 &
   Cervical              28.3      (+/-8.0%)       17.3      (+/-21.2%)           --
   Skin                  23.3      (+/-7.5%)       16.0      (+/- 9.8%)           --
   Oral                  15.0      (+/-6.4%)        2.2      (+/- 2.8%)         -12.8 &
   ---------------------------------------------------------------------------------------
   * Confidence interval.
   + Not asked.
   & p<0.001. 

   
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