Population health leaders might consider bundling cancer screenings to make it more convenient for people to access preventive care, as millions are overdue for multiple tests, according to new data in JAMA Network Open.
The report, which focuses specifically on women ages 45-64, found that around 18 million are behind on at least one routinely recommended cancer screening -- breast, cervical or colorectal cancer. Of those women, around half are due for multiple tests, the report showed.
These findings come as the U.S. works to close its broad cancer screening gaps. Earlier this year, the Prevent Cancer Foundation reported that nearly three-quarters of all U.S. adults are behind on their routine cancer screenings.
The report revealed that rising healthcare costs are keeping patients from getting recommended preventive care. Meanwhile, separate data has shown that social determinants of health and the fear of seeing a doctor can add to cost-related issues.
This latest report from researchers at Dell Medical School at the University of Texas at Austin sheds more light on the issue.
Using survey responses from over 68,000 middle-aged women, the researchers recorded trends in cancer screening uptake, as well as the barriers keeping women from getting recommended tests for breast, cervical and colorectal cancer.
Around half of the women in the study were up to date on all three cancer screening tests. That leaves 17.9 million women who are behind on at least one cancer screening, with colorectal cancer screening the most commonly missed test.
But perhaps most notable are the findings about women who are due for multiple cancer screenings. Of the 17.9 million behind on at least one test, half were behind on multiple tests.
Around half of those behind on colorectal cancer screening were due for an additional screening. For breast cancer screening, that figure was 73%, and for cervical cancer screening, it was 71%.
Reimagining cancer screening access
Could there be potential for more efficiency -- and more convenience -- in cancer screening access? Certainly, the researchers stressed.
Specifically, new population health management programs that promote bundled cancer screenings -- such as getting a mammogram and a pap smear in the same appointment -- could help patients get multiple services done at once.
This could be especially key for the 15.2 million women who were behind on two types of cancer screenings but up to date on the third. These women likely have access to care and enough health literacy to understand the importance of cancer screening.
This population might also benefit from more tailored outreach. For example, middle-aged women have long been eligible for cervical cancer screenings. But with aging comes new recommended screenings, such as mammograms and cervical cancer screenings, and better patient awareness of those services will be key.
Still, there are 3.2 million women behind on all three cancer screenings, and population health managers should also focus on these groups. According to the data, this group is disproportionately uninsured and has low healthcare utilization.
Community-based care, such as mobile clinics, may help reach this population. Policy-level changes, such as expanded access to health insurance and increased funding for federally qualified health centers, could also move the needle for this small but high-cost population.
These solutions aren't perfect. For example, mobile cancer screening requires adequate systems for follow-up in case abnormal results occur. Similarly, bundling more than one cancer screening requires clear pathways to follow up depending on test results.
The researchers urged further research into these strategies.
Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.
