How to get patients in for missed cancer screenings

As health systems and providers begin to recover from the impact of COVID-19, they are confronting a long-running problem exacerbated by the pandemic: poor cancer screening rates, especially in communities of color, that further drive disparities in health outcomes.

Doctors sounded the alarm last year when cancer screenings dropped as patients deferred routine care and appointments and healthcare facilities canceled “nonessential” care. But low cancer screening rates were already a problem before COVID-19, with communities of color in particular least likely to be screened and most likely to be diagnosed at later stages.

With renewed attention to the importance of screenings in detecting cancer early when it’s easier to treat, physicians should reexamine any practices that present barriers for patients, experts say.

“Even before the pandemic, in areas like lung cancer and colon cancer, more than half of the patients eligible to get screenings were missing them,” said Dr. Pat Basu, CEO of Cancer Treatment Centers of America.

He added that providers should start with “examining your policies and procedures and doing everything you can to keep people safe and thinking of how to make it as easy as possible for patients to get screened.”

About 10 million breast, colorectal and prostate cancer screenings were missed due to COVID-19, according to a study published in April in JAMA Oncology.

“How are we going to make up the backlog of screenings? That’s where we’re scratching our heads. It’s tens of millions of people who missed their screening,” said Dr. Lisa Richardson, director of the Centers for Disease Control and Prevention’s Division of Cancer Prevention and Control. “This is going to take all of us: public health, providers, health systems, clinics, community-based organizations, whoever we can work with to endorse screenings.”

Experts are particularly worried about the impact of missed screenings on women of color, who already experience health inequities.

The total number of cancer screening tests received by low-income and uninsured women through a CDC program declined by 87% for breast cancer and 84% for cervical cancer during April 2020 when compared to a five-year average of the same time period. That includes an 84% drop in breast cancer screenings among Hispanic women, and an 82% drop in cervical cancer screenings for Black women.

Overall, by 2015, the latest year data was available, the U.S. has not yet met breast or colorectal cancer screening targets set by the CDC, except for groups with the highest educational attainment. Lung cancer screenings for people at risk remained low.

It sounds simple, but two of the best ways for doctors to improve cancer screening rates is by recommending it to patients and sending frequent reminders.

“That’s an important piece for providers to recognize. It’s really powerful, our ability as providers to talk to patients about cancer screenings,” said Dr. Laura Makaroff, senior vice president of prevention and early detection at the American Cancer Society.

Calling or emailing patients can be helpful. And having reminders in electronic health records and population management tools can prompt providers as well.

Some practices haven’t seen screenings return to pre-pandemic levels, fueling worries that patients could be diagnosed at later stages when cancer is harder to treat.

Screenings are still down about 30% compared with pre-pandemic levels at City of Hope of Orange County, said president Annette Walker.

The organization is using public service announcements, radio and digital ads to encourage people to come back in.

“The reason cancer centers are so worried is we know that COVID didn’t stop cancer. People are still getting cancer at the same rates,” she said. “We try to get out there and advocate to people to get your screening, but it’s still not back to normal.”

She said practices should consider extending their hours or opening on weekends to increase access for people who can’t come in during the day on weekdays.

“It may be more helpful to look differently at how we’re providing our services to some of these communities,” she said.

The CDC also recommends providing rides to and from appointments, offering mobile mammography vans or pick-up locations for stool samples, helping with childcare, offering translation services and assigning staff to helping patients identify and overcome barriers to screening.

The pandemic may have helped change the conversation around accessibility, with eventually more screenings moving into the home, experts say.

“One of the things we learned during the pandemic was how to make screening more accessible and more pandemic-proof,” said Phil Castle, director of the National Cancer Institute’s Division of Cancer Prevention.

The Food and Drug Administration is working with companies on at-home screening kits for cervical cancer.

“We need to consider other ways to screen people that doesn’t require a clinic,” Castle said.

For example, one study shows that sending take-at-home tests for colorectal cancer to patients helped increase screenings by more than 1,000 % when compared with a control group that only received a text message reminder about scheduling an in-person screening, according to a study published in February in the Journal of General Internal Medicine.

Researchers sent the tests to patients overdue for testing at a community health center that predominantly serves people of color.

Still, some factors determining whether patients get cancer screenings are out of a physician’s control.

Shortages of primary-care doctors and lack of insurance coverage are significant barriers to accessing screenings, experts say.

“We have much more to do on the policy side to build a system of care that supports all these best practices and allows providers to be able to provide the best care at the right time in the right place for all patients,” said the American Cancer Society’s Makaroff.