Addressing Racial/Ethnic Disparities in Cancer Screenings Among Health Center Patients

Background: Certain racial/ethnic minority populations in the US have higher cancer prevalence and mortality, underscoring the need for prevention and early detection. In order to rectify any disparities, evidence-based screening guidelines must be implemented effectively in minority communities. Federally Qualified Health Centers (Health Centers) are supported by the Health Resources and Services Administration. They serve nearly 1 in 4 low-income individuals in the US and 1 out of 7 uninsured Americans, many of whom are racial/ethnic minorities. For patients of Health Centers, our objective is to assess the presence and magnitude of disparities among racial/ethnic groups and other key variables in the use of three types of cancer screening tests - Pap smear, mammogram, and colorectal screening (CRS), including sigmoidoscopy, colonoscopy, and home stool blood test - after accounting for confounding factors. Method: Cross-sectional analyses using the 2009 Health Center Patient Survey, with a nationally-representative sample of 4,558 patients. We estimated logistic regression models to predict the likelihood of obtaining each of three types of screening tests, after controlling for the key patient characteristics such as the presence and source of health insurance coverage, presence and number of comorbidities, and income relative to the Federal Poverty Level. Results: Among health center patients, African Americans are as likely as non-Hispanic whites to receive all three types of screening. For Pap smear and mammogram use, there are no disparities evident between Hispanics and non-Hispanic whites. Regardless of race/ethnicity, smoking is strongly associated with lower likelihood of screening. Additionally, lack of health insurance is strongly associated with lower likelihood of screening. Conclusions: Among Health Center patients, racial/ethnic minorities appear to be as likely as Whites to receive cancer screening, even after controlling for important clinical and demographic factors. Although smoking is a risk factor for cancer, in this study, smoking is associated with a decreased rate of cancer screening. We find that patients who lack health insurance coverage were less likely to be screened than those with coverage. Expansion of coverage, in terms of both availability and extent, may reduce disparities in cancer screening in all settings. Providers may need additional interventions to increase cancer screening among smokers.