Cancer screening rates are significantly lower at Federally Qualified Health Centers (FQHCs) compared to overall national rates, according to a study published in JAMA Internal Medicine. The study found screening use in FQHCs was 45.4 percent for breast cancer, 51 percent for cervical cancer and 40.2 percent for colorectal cancer, compared to cancer screening rates in the general population of 78.2 percent, 82.9 percent and 72.3 percent, respectively.
One researcher called the results disheartening, but not surprising. “Our results matched what we were seeing on the ground: screening rates are not as high in these settings as national studies would have us believe,” said Jane Montealegre, PhD, one of the study’s authors and an associate professor of behavioral science at The University of Texas MD Anderson Cancer Center.
Researchers analyzed 2020 cancer screening data for more than 16 million adults reported by 1364 FQHCs across the United States, and self-reported estimates from the Behavioral Risk Factor Surveillance System. The data include patients eligible for breast (age, 50–74 years), cervical (age, 21–64 years), and colorectal (age, 50–75 years) cancer screening.
The FQHC designation is given to non-profit clinics that serve 28.6 million people in the United States. These clinics provide care to those who are traditionally medically underserved, including racial and ethnic minorities and those who are uninsured or underinsured. These are the same populations that are disproportionately at risk of getting the cancer types on which the study focused.
“The silver lining is we have the precision data we need to know where to focus our efforts and our limited resources,” Montealegre said. As part of the study, her team looked at what screening rates would be needed to eliminate disparities. “If we were to increase cancer screening rates in FQHCs to those set by the CDC in their 2030 Healthy People goals, we would really eliminate racial and ethnic disparities in breast and cervical cancer screening,” she said. Montealegre described the goals as realistic and attainable. “If scaled-up above those goals, we could eliminate racial and ethnic disparities for all three of the cancer types and make a significant dent in the disparities between the insured and uninsured,” Montealegre added.
Montealegre pointed to two things that would significantly improve cancer screening in underserved populations: investment in implementation science and at-home testing. “We put so much emphasis on developing the actual procedures and tests and what interventions are that impact health directly, we often neglect how we are going to put those into real world practice,” Montealegre said.
For now, screening for breast cancer relies on mammography, which is usually not available at FQHCs and must be done at a specialized imaging center. But, for both cervical and colorectal cancer screening, simplified tests are already being used or are on the horizon. Simple stool-based tests in which samples are collected at home by patients and mailed into labs are already in use. Likewise, a clinical trial is underway called the Self-collection for HPV testing to Improve Cervical Cancer Prevention (SHIP). The device-assay combination being tested has already been submitted for approval to the Food and Drug Administration. “It would be a game-changer to implement more cancer screening tests at home,” she said.
