Christopher I Li

Gaps in care across the cancer screening continuum for cervical, colorectal, and lung cancers

Abstract Background Screening for cervical, colorectal, and lung cancers reduces cancer-specific mortality, but the full benefits of screening are realized only when they are coupled with timely care across the subsequent “screening continuum” steps, including surveillance (results warranting frequent monitoring), diagnostic evaluation (results that require additional testing), and treatment (detected cancers). Our goal was to describe the proportion of individuals receiving timely cervical, colorectal, and lung cancer care at each step in the screening continuum. Methods This retrospective cohort study used data from the 10 health-care settings that participate in the Population-based Research to Optimize the Screening Process, 2018 to present, consortium and included individuals who were eligible for a step along the cancer screening continuum in 2018. Proportions of individuals who received timely testing were calculated for screening, surveillance, and diagnostic tests for each of the 3 cancers and treatment (colorectal cancer only), and we evaluated the association of these outcomes with patient characteristics using multivariate logistic regression. Results The overall proportions of timely screening, surveillance, and diagnostic testing were 41.8%, 37.3%, and 61.2% for cervical cancer; 82.4%, 45.5%, and 73.5% for colorectal cancer (94.1% for timely treatment); and 73.8%, 80.5%, and 80.7% for lung cancer. Across all 3 cancers, there were differences across the screening continuum by insurance status, race and ethnicity, and socioeconomic status. Conclusions There are important gaps in care across the screening continuum beyond common metrics for screening uptake. Comparison across organ types may facilitate the identification of interventions and policies that could broadly improve cancer prevention and promote health equity.

Association between racial residential segregation and screening uptake for colorectal and cervical cancer among Black and White patients in five US health care systems

AbstractBackgroundDespite increased recognition that structural racism contributes to poorer health outcomes for racial and ethnic minorities, there are knowledge gaps about how current patterns of racial residential segregation are associated with cancer screening uptake. The authors examined associations between Black residential segregation and screening for colorectal cancer (CRC) and cervical cancer among non‐Hispanic Black and non‐Hispanic White adults.MethodsThis was a retrospective study of CRC and cervical cancer screening‐eligible adults from five health care systems within the Population‐Based Research to Optimize the Screening Process (PROSPR II) Consortium (cohort entry, 2010–2012). Residential segregation was measured using site‐specific quartiles of the Black local isolation score (LIS). The outcome was receipt of CRC or cervical cancer screening within 3 years of cohort entry (2010–2015). Logistic regression was used to calculate associations between the LIS and screening completion, adjusting for patient‐level covariates.ResultsAmong CRC (n = 642,661) and cervical cancer (n = 163,340) screening‐eligible patients, 456,526 (71.0%) and 106,124 (65.0%), respectively, received screening. Across PROSPR sites, living in neighborhoods with higher LIS tended to be associated with lower odds of CRC screening (Kaiser Permanente Northern California: adjusted odds ratio [aOR] LIS trend in Black patients, 0.95 [p < .001]; aOR LIS trend in White patients, 0.98 [p < .001]; Kaiser Permanente Southern California: aOR LIS trend in Black patients, 0.98 [p = .026]; aOR LIS trend in White patients, 1.01 [p = .023]; Kaiser Permanente Washington: aOR LIS trend in White patients, 0.97 [p = .002]. However, for cervical cancer screening, associations with the LIS varied by site and race (Kaiser Permanente Washington: aOR LIS trend in White patients, 0.95 [p < .001]; Mass General Brigham: aOR LIS trend in Black patients, 1.12 [p < .001]; aOR LIS trend in White patients, 1.03 [p < .001]).ConclusionsAcross five diverse health care systems, the direction of the association between Black residential segregation and screening varied by PROSPR site, race, and screening type. Additional research, including studies that examine multiple dimensions of segregation and structural racism using intersectional approaches, are needed to further disentangle these relationships.