Measuring the Validity of Survey Questions on Breast, Cervical, Colorectal, and Lung Cancer Screening

Document Type

Article

Publication Date

2-27-2026

Publication Title

American journal of epidemiology

Keywords

cancer screening; survey; validity

Abstract

BACKGROUND: The National Health Interview Survey (NHIS) is used to measure progress on cancer screening. We assessed validity of questions on cervical, colorectal, breast, and lung cancer screening from the 2020, 2021, and 2022 NHIS, using electronic medical records as our standard for accuracy.

METHODS: We surveyed 1,770 adults ages 21+ years for breast, cervical, colorectal, and lung cancer from four US health systems. We made slight changes in question order and wording to improve understanding of questions. We compared survey responses for screening adherence with electronic medical record (EMR) data as a gold standard, calculating sensitivity, specificity, positive predictive value, negative predictive value, Cohen's Kappa, and reports-to-records ratio.

RESULTS: Self-reported screening adherence had high sensitivity for most cancer types (range 0.79-0.96). We found good agreement for breast cancer screening using Cohen's Kappa (0.81) and more modest agreement for the other three cancer sites (0.59-0.65). The reports-to-records ratio showed over-reporting cancer screening ranging from 12% to ⁓50% more screening reported for the USPSTF recommended screening periodicity compared to medical record data.

CONCLUSIONS: NHIS questions that assess cancer screening provide reasonably accurate estimates. However, some misclassification with expected bias toward over-reporting screening suggests that improvements in measuring screening adherence are needed.

PubMed ID

41755645

ePublication

ePub ahead of print

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