Researchers at University of California San Diego and collaborating institutions have shed light on the ways that social risks, such as housing or food insecurity, pose barriers to routine cancer screenings. The study, published in JNCI Cancer Spectrum, found that patients experiencing social risks were less likely to receive orders for cancer screenings and even less likely to complete screenings when ordered. The study also found that patients experiencing social risks had higher rates of primary care visits, suggesting that access to care is not the main barrier to cancer screening in this population.

The team used electronic health record data from OCHIN, a national nonprofit health IT consultancy and provider of electronic health record services for community health centers and rural hospitals, to study the associations between social risks and receipt of screening for three common cancers — cervical, colorectal and breast cancers — among patients at 186 community-based health care organizations (CBHCOs) across 13 states. CBHCOs provide essential care to underserved communities at no or little cost. For low-income, rural and immigrant populations, CBHCOs are often the only way for patients to access cancer screenings and other essential preventative care. However, despite having access to care through a CBHCO, these patients still experience a greater burden of social risks than the general U.S. population.

The study’s key findings include:

• Health care providers were less likely to order all three types of cancer screenings for patients with food insecurity, and cervical cancer screenings were ordered less often for patients with transportation insecurity.

• Patients with food insecurity were less likely to complete ordered screenings for cervical and colorectal cancer, but patients with transportation insecurity were less likely to complete ordered screenings for colorectal cancer only.

• The likelihood of completing an ordered breast cancer screening did not differ significantly in patients with social risks compared to those without.

While further research is needed to identify the root cause of these varied trends, the researchers hypothesize that patients with food insecurity may be less likely to be ordered cancer screenings because the urgency of food insecurity may shift the focus of primary care visits toward addressing more acute health risks, leading to delays in preventive care. Additionally, once cancer screenings are ordered, it may be difficult for patients to follow through and complete screenings that require additional appointments or procedures, such as a colonoscopy or a Papanicolaou (Pap) test. In contrast, mammograms are relatively easy for patients to complete, in part because outreach programs like mobile mammography clinics support mammogram access.

Banegas noted that the study's findings are particularly relevant in the context of recent policy changes aimed at addressing social determinants of health.

However, the findings also highlight the need for health care providers to take a more holistic approach to patient care in order to appropriately address social risk proactively in the clinic.

Newswise/DrSB