Study: Cancer screening rates lower in federally qualified health centers

Key takeaways:

• Cancer screenings were lower in FQHCs nationally and across states.
• The data highlight “an urgent need” to scale up screenings to reduce cancer disparities, a study author said.

Screenings for breast, cervical and colorectal cancers were significantly lower in federally qualified health centers compared with the general population, a study in JAMA Internal Medicine showed.

Federally qualified health centers, or FQHCs, “provide high-quality primary care to underserved communities in the United States, which are disproportionately composed of racial and ethnic minorities, people without health insurance, and those living below the poverty level,” Jane R. Montealegre, PhD, an associate professor of Behavioral Science at the University of Texas MD Anderson Cancer Center, said in a press release.

“These findings highlight an urgent need to focus on scaling up evidence-based screenings in these populations to mitigate cancer disparities,” she said.

In the study, Montealegre and colleagues assessed cancer screening data from Jan. 1 through Dec. 31, 2020, at 1,364 FQHCs across the U.S., along with self-reported national estimates from the Behavioral Risk Factor Surveillance System.

Overall, there were 16,696,692 adults served by FQHCs who were eligible for cervical, breast or colorectal cancer screening.

Montealegre and colleagues found that screening use among the general population was:

• 82.9% (95% CI, 82.3-83.4) for cervical cancer;
• 78.2% (95% CI, 77.6-78.9) for breast cancer; and
• 72.3% (95% CI, 71.7-72.8) for colorectal cancer.

In comparison, screening use in FQHCs was:

• 51% (95% CI, 51-51.1) for cervical cancer;
• 45.4% (95% CI, 45.4-45.5) for breast cancer; and
• 40.2% (95% CI, 40.1-40.2) for colorectal cancer.

The researchers estimated the contribution of the underscreened population served by FQHCs to the national underscreened general population. They reported that the underscreened population in FQHCs accounted for:

• 29.7% (95% uncertainty interval [UI], 28.8-30.7) of the overall underscreened population for cervical cancer;
• 16.9% (95% UI, 16.4-17.4) of the overall underscreened population for breast cancer; and
• 14.7% (95% UI, 14.4-15) of the overall underscreened population for colorectal cancer.

The release noted that FQHC screening use varied significantly by state. For example, Maine and New Hampshire had screening rates above 60%, whereas states like Utah, Wyoming and Alabama had screening rates below 35%. Still, screening disparities were observed nationally and across states, according to the researchers.

Montealegre and colleagues also found that optimizing screening to 100% use in FQHCs could improve screening in diverse populations by 7.7%, 7.3% and 8.5% for breast, cervical and colorectal cancer, respectively.

“The FQHCs often need to find alternative funding sources, such as grants from the state or federal government,” they wrote. “Such system-level barriers are associated with reduced opportunities for cancer screening.”

The researchers highlighted a finding that screening disparities between FQHCs and the general population were lowest for colorectal cancer, which could show a need for implementation of newer, more feasible self-collected stool-based tests.

There were some study limitations, according to the researchers. National screening data may have been overestimated as a result of self-reporting, whereas FQHC screening data may have been underestimated because of the use of medical record-derived data, “particularly because the FQHC denominator may include patients only sporadically seeking care in FQHCs who may have undergone cancer screening elsewhere,” Montealegre and colleagues wrote.

Ultimately, “addressing health care organizational factors and designing strategies that can improve care coordination across fragmented health care systems is an important step in the direction of health equity, since care coordination studies continue to highlight the impact on increasing cancer health disparities,” the researchers concluded.

References:

• Cancer screening rates are significantly lower in U.S. federally qualified health centers. https://www.mdanderson.org/newsroom/cancer-screening-rates-are-significantly-lower-in-u-s-federally-qualified-health-centers.h00-159696756.html. Published April 29, 2024. Accessed May 2, 2024.
• Amboree T, et al. JAMA Intern Med. 2024;doi:10.1001/jamainternmed.2024.0693.