Cancer screening disparities continue to draw scrutiny in radiology. A new study in JAMA Network Open takes a closer look at why some people don’t get screened as often as they should – as well as the factors that contribute to cancer prevalence and mortality.
There’s extensive research backing the lifesaving potential of the major cancer screening exams, and cancer mortality rates have consistently declined thanks to the combination of screening and better treatments.
- But the declines are uneven, prompting researchers to investigate reasons for the disparities, such as in a study earlier this month documenting geographic variations in cancer screening rates.
In the new study, researchers from the ACR’s Harvey L. Neiman Health Policy Institute looked at how 24 measures like lifestyle, socioeconomic status, and environmental background affected breast, prostate, lung, and colorectal cancer, which account for 50% of new cancer cases.
- In particular, they examined screening completion rates and cancer prevalence and mortality at the county level in a nationally representative sample of 5% of Medicare fee-for-service beneficiaries, of whom 87% were 65 years and older.
There’s a lot to unpack in the study, but a few highlights are below as they relate to breast and lung cancer, the two cancers for which imaging-based screening is recommended. The top three factors affecting each (in order of importance) are…
- Breast cancer:
- Screening rates – Hispanic population share, levels of insufficient sleep, and poverty.
- Prevalence – uninsured status, obesity, and housing insecurity.
- Mortality – non-Hispanic Black race, environmental justice index, and insufficient sleep.
- Lung cancer:
- Screening rates – air pollution exposure, lack of access to primary care physicians, and number of poor physical health days.
- Prevalence – limited access to healthy foods, uninsured status, and severe housing problems.
- Mortality – smoking, poor physical health days, and environmental justice index.
While there are some obvious findings in the data (the connection between smoking and lung cancer mortality, for example), the dominance of socioeconomic measures may take some by surprise (or maybe not).
- But they do track with previous research finding that socioeconomic factors account for 40-50% of health impacts.
The Takeaway
The new study – as with previous research – reinforces what we know about the strong connection between socioeconomic status and cancer screening disparities. The new data should give clinicians and public health advocates more detail on the specific factors they need to focus on to improve screening compliance and reduce cancer’s burden on society.
