Cancer Screening Rates Lag in US Federally Qualified Health Centers

Trisha Amboree, PhD

According to a national study, breast, cervical, and colorectal cancer screening use was substantially lower, both nationally and across states, among populations served by federally qualified health centers (FQHCs). Of the population served by FQHCs, the national underscreened general population was 16.9% for breast cancer, 29.7% for cervical cancer, and 14.7% for colorectal cancer screening.¹

“Federally qualified health centers play an essential role in delivering primary healthcare to underserved communities in the US. However, our study reveals a concerning disparity that at the national and state level, use of breast, cervical, and colorectal cancer screening is significantly lower in FQHCs relative to the overall US population. Addressing this gap could aid in reducing cancer-related inequalities,” Trisha Amboree, PhD, lead author and postdoctoral fellow at The University of Texas MD Anderson Cancer Center, told Targeted Oncology^TM.

The study was led by researchers at The University of Texas MD Anderson Cancer Center and The University of New Mexico Comprehensive Cancer Center and findings were published in JAMA Internal Medicine. A total of 3,162,882; 7,444,465; and 6,089,345 breast, cervical, and colorectal screening-eligible individuals were served by FQHCs in 2020.^1,2

Findings showed that in FQHCs, screening use was 45.4% (95% CI, 45.4%-45.5%) for breast cancer, 51% (95% CI, 51.0%-51.1%) for cervical cancer, and 40.2% (95% CI, 40.1%-40.2%) for colorectal cancer. This compared with screening rates of 78.2% (95% CI, 77.6%-78.9%), 82.9% (95% CI, 82.3%-83.4%), and 72.3% (95% CI, 71.7%-72.8%) in the general US population, respectively.

“By investing in targeted research on improving screening rates within FQHCs, there is potential to mitigate screening-related disparities in medically underserved populations," continued Amboree.

In the cross-sectional study looking at cancer screening rates, data from January 1, 2020, to December 31, 2020, were utilized from the FQHC Uniform Data System. These data were reported by 1364 FQHCs across the US, as well as self-reported estimates from the Behavioral Risk Factor Surveillance System.

A total of 16,696,692 US adults served by FQHCs were included. These patients were eligible for breast, cervical, and colorectal cancer screening. Patients eligible for breast screening ranged from 50 to 74 years of age, patients eligible for cervical cancer screening ranged from 21 to 64 years of age, and those eligible for colorectal cancer screening were 50 to 75 years of age. Experts conducted these analyses between January 1, 2023, and June 30, 2023.

Among those included, 62.2% were from racially and ethnically minority groups, with 36.8% being Hispanic or Latino. A total of 24.4% of patients reported a primary language other than English, 90.6% of patients were at or below the 200% federal poverty level (FPL), and 68.0% were at or below 100% FPL.

Cancer detection and screening as a treatment for malignant cells with a biopsy or testing caused by carcinogens and genetics with a cancerous cell as an immunotherapy symbol: © freshidea - stock.adobe.com

Further, 21.8% of those enrolled had no health insurance, 46.9% had Medicaid or were in the Children’s Health Insurance Program, and 10.4% had Medicare. Those experiencing homelessness made up 4.5% of the population, and 18.1% were residents of public housing.

Additional findings showed that screening rates varied greatly across states. Some, like Maine and New Hampshire, exceeded 60%, while others, like Utah, Wyoming, and Alabama, fell below 35%. Of note, underscreened populations served by FQHCs in these low-performing states contribute heavily to the national problem.

According to this research, experts believe this disparity stems from variations in state-run screening programs and healthcare funding policies.

Overall, these findings demonstrate that there is a major screening gap among minoritized populations, which could have important implications for addressing disparities. To ensure access to cancer screenings for all, future policies and resources should prioritize strengthening FQHCs. This can be achieved through systematic implementation programs that directly address unmet screening needs in underserved communities.

“Future research is needed to better understand contributors to gaps in screening use in FQHCs and implement evidence-based, equitable strategies to improve cancer screening in FQHCs,” added Amboree.

REFERENCES:

1. Amboree TL, Montealegre JR, Parker SL, et al. National breast, cervical, and colorectal cancer screening use in federally qualified health centers. JAMA Intern Med. Published online April 29, 2024. doi:10.1001/jamainternmed.2024.0693

2. Cancer screening rates are significantly lower in U.S. Federally Qualified Health Centers. News release. MD Anderson Cancer Center. April 29, 2024. Accessed April 30, 2024. https://tinyurl.com/y4r9rsfh