U.S. federally qualified health centers (FQHCs) -- intended to provide care to underserved populations across the country -- show prominent cancer screening gaps, researchers have reported.
A team led by Trisha Amboree, PhD, of the University of Texas MD Anderson Cancer Center in Houston found that the cancer screening gap manifested at FQHCs -- for breast, cervical, and colorectal cancer -- contributes significantly to the percentage of underscreened individuals across the country. The study findings were published April 29 in JAMA Internal Medicine.
"[Our] findings highlight the urgency of scaling up screening use in FQHCs," the group wrote.
The U.S. Preventive Services Task Force (USPSTF) recommends age-based screening in the average-risk general population for breast, cervical, and colorectal cancers, but "screening use remains suboptimal, particularly among uninsured, medically underserved, and racially and ethnically minoritized populations," the group noted.
These populations often receive health care services, including cancer screening, from safety-net settings that provide care at low cost or on a sliding scale based on individuals’ ability to pay," the team wrote. "Federally qualified health centers (FQHCs) are important safety nets that provide health services to roughly 30 million people in the U.S. [and] play a critical role in providing cancer prevention services including breast, cervical, and colorectal cancer screenings. However, financial constraints, limited resources, and staff turnover often hinder the capacity and ability of FQHCs to provide screening services."
Amboree's group investigated FQHC screening rates and compared them to general U.S. screening rates. The team used information from 16.7 million U.S. adults eligible for breast, cervical, and colorectal cancer screening taken from the 2020 FQHC Uniform Data System. Of the total study cohort, 3.2 million underwent breast cancer screening; 7.4 million cervical cancer screening; and 6.1 million colorectal cancer screening.
The team found significant discrepancies in screening use in FQHCs compared to other screening entities.
| Differences between cancer screening among patients served by FQHCs and general U.S. population, 2020 | ||
|---|---|---|
| Type of screening exam | FQHCs | General U.S. population |
| Breast cancer | 45.4% | 78.2% |
| Cervical cancer | 51% | 82.9% |
| Colorectal cancer | 40.2% | 72.3% |
The investigators also reported that the contribution of the underscreened population served by FQHCs to the national underscreened general population was the following:
- 16.9% for breast cancer
- 29.7% for cervical cancer
- 14.7% for colorectal cancer
"These findings highlight a major screening gap among minoritized populations and could have important implications for addressing disparities," according to Amboree and colleagues.
In an accompanying commentary, Jennifer Spencer, PhD, and Michael Pignone, MD, both of the University of Texas at Austin, outlined some measures that could be taken to boost FQHC cancer screening rates.
"The most wide-reaching strategies would address structural barriers through state and national policy efforts," Spencer and Pignone wrote. "These include completing expansion of Medicaid in states where it has not yet been implemented and improving Medicaid reimbursement in all states; expanding funding for the Centers for Disease Control breast, cervical, and colorectal cancer screening initiatives, including ensuring funding for treatment of cancers or precancers detected through screening efforts; and increasing existing federal funding or creating novel financing to support greater FQHC adoption of team-based comprehensive care."
The complete study can be found here.
