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How Important Is the Preventive Health Examination?

Joshua J. Fenton, MD, MPH; Yong Cai, PhD; Noel S. Weiss, MD, DrPH; Joann G. Elmore, MD, MPH; Roy E. Pardee, JD, MA; Robert J. Reid, MD, PhD; Laura-Mae Baldwin, MD, MPH

Arch Intern Med. 2007;167(6):580-585.

Background  Patients and physicians strongly endorse the importance of preventive or periodic health examinations (PHEs). However, the extent to which PHEs contribute to the delivery of cancer screening is uncertain.

Methods  In a retrospective cohort study, we determined the association between receipt of a PHE and cancer testing in a population-based sample of enrollees in a Washington State health plan who were aged 52 to 78 years and eligible for colorectal, breast, or prostate cancer screening in 2002-2003 (N = 64 288). Outcomes included completion of any colorectal cancer testing (fecal occult blood testing, sigmoidoscopy, colonoscopy, or barium enema), screening mammography, and prostate-specific antigen testing.

Results  More than half (52.4%) of the enrollees received a PHE during the study period. After adjusting for demographics, comorbidity, number of outpatient visits, and historical preventive service use before January 1, 2002, receipt of a PHE was significantly associated with completion of colorectal cancer testing (incidence difference, 40.4% [95% confidence interval (CI), 39.4%-41.3%]; relative incidence, 3.47 [95% CI, 3.34-3.59]), screening mammography [incidence difference, 14.2% [95% CI, 12.7%-15.7%]; relative incidence, 1.23 [95% CI, 1.20-1.25]), and prostate-specific antigen testing (incidence difference, 39.4% [95% CI, 38.3%-40.5%]; relative incidence, 3.06 [95% CI, 2.95-3.18]).

Conclusions  Among managed care enrollees eligible for cancer screening, PHE receipt is associated with completion of colorectal, breast, and prostate cancer testing. In similar populations, the PHE may serve as a clinically important forum for the promotion of evidence-based colorectal cancer and breast cancer screening and of screening with relatively less empirical support, such as prostate cancer screening.

Author Affiliations: Department of Family and Community Medicine, University of California, Davis, Sacramento (Dr Fenton); Departments of Family Medicine (Drs Cai and Baldwin), Epidemiology (Drs Weiss and Elmore), and Medicine (Dr Elmore), University of Washington, Seattle; and Center for Health Studies (Mr Pardee and Dr Reid) and Department of Preventive Medicine (Dr Reid), Group Health Cooperative, Seattle.

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