SEATTLE -- The path to lower cancer mortality begins with comprehensive screening programs and equitable access to screening services, a member of a presidential panel on cancer screening said here.
At the height of the COVID-19 pandemic, cancer screening declined dramatically, including a 90% drop in breast cancer screening. While screening rates have since recovered, the National Cancer Institute estimates that the pandemic-associated dip will mean more diagnoses of later-stage cancers in the near future.
Moreover, barriers to screening and associated disparities in uptake and access continue to contribute to uneven outcomes, including mortality, said Edith Mitchell, MD, of the Sidney Kimmel Cancer Center at Thomas Jefferson University in Philadelphia, during the .
A key first step is to use a visit for one type of cancer screening as an opportunity to recommend screening for other types of cancer, suggested Mitchell, who is one of three members of the (PCP).
"When we request a mammogram, let's make sure that individual gets information on other cancers, so that we can determine their risk for other malignancies and enact appropriate screening programs," she said. "This all started with breast cancer screening; let's use that breast cancer platform and screen for all other appropriate cancers for each individual."
Improved access to comprehensive, appropriate and equitable cancer screenings will help find cancers earlier. If followed by appropriate diagnostic and therapeutic interventions, patient outcomes -- including survival -- will improve, she added.
The PCP, appointed by President Biden to advise him on the National Cancer Program, recently published to close gaps and increase uptake in cancer screenings. Prior to developing the recommendations, the PCP convened a series of public meetings involving more than 160 stakeholders, including patients, advocates, primary care physicians, specialists, insurers, and others. The meetings focused on barriers and opportunities for breast, cervical, colorectal, and lung cancer screening, as well as innovations in cancer screening.
As a result of the meetings, the PCP identified significant gaps between recommended cancer screening and uptake, as well as shortcomings in timely follow-up after abnormal test results, particularly in communities of color, socially and economically disadvantaged populations, and less-educated communities.
Disparities in screening varied by malignancy: Screening rates for colorectal, breast and cervical cancers have increased over several decades, whereas lung cancer screening rates remained stagnant.
Mitchell cited multiple barriers to screening uptake, including logistical challenges, cost, and fear or stigma, but paramount among these barriers is lack of awareness, education and understanding about the importance of cancer screenings.
"Addressing this is so important to closing the gaps in cancer screening," she said.
The PCP defined four clear goals in its report: improving and aligning communication, facilitating equitable access, strengthening workforce collaborations, and creating effective health information technology to better support providers and healthcare systems. The Panel has also said it intends to boost funding for national cancer roundtables. Earlier this year the American Cancer Society announced plans for breast and cervical cancer roundtables, adding to existing groups for and cancers.
Facilitating equitable access will require community-oriented outreach and support – particularly through establishing a network of community health workers – as well as increasing access to self-sampling. Because providers have competing demands that make it difficult to address all patient needs during a short visit, every member of the healthcare team should support cancer screenings.
"Healthcare in this country is expensive, stove-piped, and therefore not collaboratively combined," said Mitchell. "So we need to strengthen our workforce collaborations."
Collaborative efforts are especially important for lung cancer screening, which has specific requirements for the individual practitioner conducting the screening. Because other personnel can perform many of these duties, modifying lung cancer screening requirements would facilitate workforce collaboration and support team-based approaches.
Mitchell also cited a need to increase screening opportunities for women with a history of breast cancer or who need BRCA screening.
"Many individuals are not even offered genetic testing after a breast cancer diagnosis, and this is especially true for racial and ethnic minorities," she said.
The full report of the President's Cancer Panel is .
Disclosures
The summit was sponsored by the Binaytara Foundation.
Mitchell disclosed relationships with Genentech, Astellas, Amgen, Pfizer, Regeneron, and Sema4.
Primary Source
Summit on Cancer Health Disparities
Mitchell E "Closing gaps in cancer screening: Connecting people, communities and systems to improve equity and access" SCHD 2022; Breast Cancer Disparities Session.