Study: Cancer Screenings Lower Among Populations Served by FQHCs

A national study published in JAMA Internal Medicine found major gaps in breast, cervical, and colorectal cancer screening use in Federally Qualified Health Centers (FQHCs), relative to overall screening rates in the country.

Led by researchers at the University of Texas MD Anderson Cancer Center and the University of New Mexico (UNM) Comprehensive Cancer Center, the study revealed 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 American population of 78.2 percent, 82.9 percent and 72.3 percent, respectively.

“FQHCs provide high-quality primary care to underserved communities in the US, which are disproportionately comprised of racial and ethnic minorities, people without health insurance, and those living below the poverty level,” said study author Jane Montealegre, Ph.D., in a statement.

“These findings highlight an urgent need to focus on scaling up evidence-based screenings in these populations to mitigate cancer disparities, added Montealegre, associate professor of behavioral science at MD Anderson. 

The U.S. Preventive Services Task Force (USPSTF) offers guidance for the general population to get screened for breast, cervical and colorectal cancer based on age and family history. However, screening use remains suboptimal in many marginalized populations. About 30 million people in the U.S. who might not otherwise have access to medical services currently use FQHCs, the researchers said.

The study, led by postdoctoral fellow Trisha Amboree, Ph.D., examined screening information from the Health Center Program Uniform Data System (UDS) from 1,364 FQHCs between January 1 and December 31, 2020. To understand screening in the general population, researchers evaluated data from the Behavioral Risk Factor Surveillance System, which includes the use of preventive health services for non-institutionalized U.S. adults over the age of 18, during the same time period.

Researchers found cancer screening use in FQHCs varied widely across states. Certain states, such as Maine and New Hampshire, achieved screening rates over 60 percent and others fell below 35 percent, including Utah, Wyoming and Alabama. Additionally, the study revealed under-screened populations served by FQHCs in specific states contributed to a large proportion of America’s overall under-screened population. Experts attribute these differences, in part, to the variability of state screening programs and policies around healthcare funding.

“FQHCs 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,” said corresponding author Prajakta Adsul, M.B.B.S., Ph.D., assistant professor of Internal Medicine at UNM, in a statement. “With investments in implementation research in FQHCs, there is potential to mitigate screening-related disparities in medically underserved populations.”

 Limitations of the study include self-reporting in the datasets and potential effects from the COVID-19 pandemic, the researchers said.