Public health key to improved cancer screening

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Public health infrastructure should be leveraged and bolstered to improve current cancer screening rates and develop a comprehensive national approach to cancer control, according to an editorial published online May 9 in CA: A Cancer Journal for Clinicians

Marcus Plescia, MD, MPH, director, division of cancer prevention and control at the Centers for Disease Control and Prevention in Atlanta, and colleagues outlined the case for a stronger, more streamlined approach to cancer screening and control.

Plescia and colleagues wrote that screening rates for breast and cervical cancers have not improved in nearly a decade and colorectal screening rates remain unacceptably low.

Although expanded coverage authorized by the Patient Protection and Affordable Care Act will help close insurance gaps, other barriers to screening remain. For example, screening participation rates hover in the 50 to 75 percent range for colorectal cancer screening and mammography among adults with health insurance and regular access to medical care.

The editorialists recommended expansion of infrastructure to promote and ensure screening, including the development of centralized data systems for cancer screening. Strategies include evidence-based interventions, such as patient reminders, which can boost screening rates.

However, applying such strategies in the current fragmented system represents a challenge. Only 40 percent of primary care providers reported having a system in place to remind patients about breast or cervical cancer screenings, according to Plescia and colleagues. The authors suggested that the patient-centered medical home could provide a model to enhance delivery of clinical preventive services. They also recommended development of systems to actively identify insured individuals eligible to participate in recommended screening.

Centralized data systems could be exploited to improve accuracy of cancer screening surveillance, according to the authors. They suggested a tiered approach to reminders for eligible adults, starting with telephone, mail and electronic reminders and incorporating case management and patient navigation for underserved communities impacted by healthcare disparities.

“In particular, public health departments have a tremendous opportunity to work collaboratively with state Medicaid programs to increase cancer screening from Medicaid programs as previously uninsured adults become eligible. … Agencies could also develop data linkages and clinical registries to monitor participation, diagnostic follow-up, treatment initiation, and long-term outcomes.”

Finally, Plescia et al suggested building systems to improve follow-up of patients with abnormal screening tests.