The rates of breast, cervical, and colorectal cancer screenings in Federally Qualified Health Centers may be substantially lower compared with overall screening rates in the United States, according to a recent study published by Amboree et al in JAMA Internal Medicine.
Background
The U.S. Preventive Services Task Force (USPSTF) offers breast, cervical, and colorectal cancer screening guidance for the general population based on age and family history. However, screening use remains suboptimal in many marginalized populations. About 30 million U.S. individuals who might not otherwise have access to medical services currently visit Federally Qualified Health Centers.
“[Federally Qualified Health Centers] provide high-quality primary care to underserved communities in the [United States]—which are disproportionately comprised of racial and ethnic minorities, [patients] without health insurance, and those living below the poverty level,” explained co–study author Jane Montealegre, PhD, Associate Professor of Behavioral Science at The University of Texas MD Anderson Cancer Center. “These findings highlight an urgent need to focus on scaling up evidence-based screenings in these populations to mitigate cancer disparities,” she added.
Study Methods and Results
In the recent study, investigators used the Health Center Program Uniform Data System to examine the screening information of 1,364 Federally Qualified Health Centers between January 1 and December 31, 2020. They also evaluated data from the Behavioral Risk Factor Surveillance System—which includes the use of preventive health services for noninstitutionalized U.S. adults older than 18 years—to understand breast, cervical, and colorectal cancer screening rates in the general population.
Compared with the national cancer screening rates in the general population, the investigators found that screening use in Federally Qualified Health Centers was 45.4% vs 78.2% for breast cancer, 51% vs 82.9% for cervical cancer, and 40.2% vs 72.3% for colorectal cancer.
Further, they found cancer screening use in Federally Qualified Health Centers varied widely across states. For instance, certain states such as Maine and New Hampshire achieved screening rates over 60%; whereas other states like Utah, Wyoming, and Alabama fell below 35%. The investigators discovered that underscreened patient populations who visited Federally Qualified Health Centers in specific states contributed to a large proportion of the United States’ overall underscreened population. They attribute these differences, in part, to the variability of state screening programs and policies around health-care funding.
Conclusions
The investigators cited limitations of their recent, including self-reporting in the datasets and the potential effects of the COVID-19 pandemic.
“[Federally Qualified Health Centers] face financial constraints and staff turnover while trying to provide care in a fragmented health system. Implementing clinical preventive services such as cancer screenings will require additional support,” underscored senior study author Prajakta Adsul, MBBS, MPH, PhD, Assistant Professor of Internal Medicine at the University of New Mexico. “With investments in implementation research in [Federally Qualified Health Centers], there is potential to mitigate screening-related disparities in medically underserved populations,” she concluded.
Disclosure: The research in this study was supported by the National Institutes of Health. For full disclosures of the study authors, visit jamanetwork.com.
