Low Rates of Lung and Colorectal Cancer Screening Uptake Among a Safety-net Emergency Department Population

Abstract

Introduction: A suspected diagnosis of cancer through an emergency department (ED) visit is associated with poor clinical outcomes. The purpose of this study was to explore the rate at which ED patients attend cancer screenings for lung, colorectal (CRC), and breast cancers based on national guidelines set forth by the United States Preventive Services Task Force (USPSTF). Methods: This was a prospective cohort study. Patients were randomly approached in the Eskenazi Hospital ED between August 2019–February 2020 and were surveyed to determine whether they would be eligible and had attended lung, CRC, and breast cancer screenings, as well as their awareness of lung cancer screening with low-dose computed tomography (LDCT). Patients who were English-speaking and ≥18 years old, and who were not critically ill or intoxicated or being seen for acute decompensated psychiatric illness were offered enrollment. Enrolled subjects were surveyed to determine eligibility for lung, colorectal, and breast cancer screenings based on guidelines set by the USPSTF. No cancer screenings were actually done during the ED visit. Results: A total of 500 patients were enrolled in this study. More participants were female (54.4%), and a majority were Black (53.0%). Most participants had both insurance (80.2%) and access to primary care (62.8%). Among the entire cohort, 63.0% identified as smokers, and 62.2% (140/225) of the 50- to 80-year-old participants qualified for lung cancer screening. No patients were screened for lung cancer in this cohort (0/225). Only 0.6% (3/500) were aware that LDCT was the preferred method for screening. Based on pack years, 35.5% (32/90) of the patients who were 40-49 years old and 6.7% (6/90) of those 30–39 years old would eventually qualify for screening. Regarding CRC screening, 43.6% (218/500) of the entire cohort was eligible. However, of those patients only 54% (118/218) had been screened. Comparatively, 77.7% (87/112) of the eligible females had been screened for breast cancer, but only 54.5% (61/112) had been screened in the prior two years. Conclusion: Many ED patients are not screened for lung/colorectal/breast cancers even though many are eligible and have reported access to primary care. This study demonstrates an opportunity and a need to address cancer screening in the ED.

Characteristics and Barriers of Emergency Department Patients Overdue for Cancer Screening

“…Despite the fact that only 8.3% of participants reported that COVID-19 delayed their cancer screening, our findings found relatively high rates of patients overdue on screening compared to past studies conducted in the ED prior to the pandemic (overdue rates 12–33% for cervical, 9 – 11 12–46% for breast, 5 , 10 – 12 and 17–46% for CRC screening 5 , 12 , 13 ). Our higher rates of overdue screenings were probably due not to the pandemic but may have been related to the characteristics of our patient population.…”

“…Our higher rates of overdue screenings were probably due not to the pandemic but may have been related to the characteristics of our patient population. Our study had much higher percentages of Asian (7%) and Hispanic (30%) participants than other similar studies, which had 1-3% 5,9,10,13 and 7-18%, 5,[10][11][12][13]25 respectively. Additionally, in our study Spanish-speaking patients represented 15% of all participants.…”

“…Past studies of cancer screening adherence for eligible ED patients have found that 12-33% of women were overdue or had uncertain adherence with cervical cancer screening [9][10][11] ; 12-46% of women were overdue for breast cancer screening 5,[10][11][12] ; and 17-46% were overdue for CRC screening. 5,12,13 The percentage of patients overdue for cancer screenings has been significantly higher for those who have no insurance 5,9,10,13 or a primary care physician, 9,13 and patients with less education, 5,9,13 with mixed findings on the role of race and ethnicity, 5,9,[11][12][13] However, these studies occurred prior to the coronavirus 2019 (COVID-19) pandemic.…”

“…Past studies of cancer screening adherence for eligible ED patients have found that 12-33% of women were overdue or had uncertain adherence with cervical cancer screening [9][10][11] ; 12-46% of women were overdue for breast cancer screening 5,[10][11][12] ; and 17-46% were overdue for CRC screening. 5,12,13 The percentage of patients overdue for cancer screenings has been significantly higher for those who have no insurance 5,9,10,13 or a primary care physician, 9,13 and patients with less education, 5,9,13 with mixed findings on the role of race and ethnicity, 5,9,[11][12][13] However, these studies occurred prior to the coronavirus 2019 (COVID-19) pandemic. Results from large national surveys showed that approximately 55% of respondents reported that they or someone in their household delayed or skipped routine medical care during the pandemic, 14,15 suggesting that rates of being overdue for cancer screening may be higher post-pandemic and/or more disparate for some groups of patients.…”

Cancer Screening Abstinence Rates and Rationales Among Regular Outpatients at a Rural Hospital in Japan: A Cross-Sectional Study

“…However, preliminary observations and existing literature suggest that regular outpatients might not have higher uptake rates for cancer screening than of the general population. 7,8 Identifying the reasons behind this could reveal specific barriers or misconceptions, even among those with relatively easy access to healthcare services, thereby guiding targeted interventions to enhance cancer screening rates within this subgroup.…”