Abstract PR020: Predictors of cancer screening in federally qualified health centers in the United States: A cross sectional study
Authors: Stuckwisch Ashley M. , Narayan Anand K. 
Published: December 2023

Background: Patients from medically underserved populations are less likely to have access to cancer screening. Federally Qualified Health Centers (FQHCs) provide primary care services for medically under-served communities on a sliding-fee scale and are well-positioned to increase equity in cancer screening access. However, there is limited data about predictors and patterns of cancer screening among FQHC patients. The purpose of our study was to evaluate predictors and patterns of breast, colorectal, and cervical cancer screening in FQHCs across the United States. Methods: Data on the FQHCs was obtained from publicly available data sets from the Health Resources and Services Administration and included locations across the United States. Primary outcomes included breast, colorectal, and cervical cancer screening percentages. Primary exposures included the number of patients; percentages of patients by race/ethnicity, primary language, poverty threshold, and insurance status. Descriptive statistics (median and IQR) were obtained for all continuous variables. Spearman’s correlation coefficients were estimated to evaluate the association between cancer screening percentages and primary exposures. Results: We analyzed data from 1,375 FQHCs. The median population size served was 12,404 (IQR 6,084-24,757) patients, with 12% (IQR 2-38) Black/African American, 18% (IQR 5-48) Hispanic/Latino, 1% (IQR 1-3) Asian, and 1% (IQR 0-2) American Indian/Alaska Native patients. The median percentage of patients below the 100% poverty line was 66% (IQR 52-78), the percentage of uninsured patients was 19% (IQR 11-31), and the percentage of patients with Medicaid was 42% (IQR 28-57). 13% of patients preferred receiving care in a language other than English (IQR 3-32). Median percentage of mammography screening was 44% (IQR 31-56).  Percentage of uninsured patients was negatively correlated with mammography screening percentages (r = -0.23, p &lt; 0.001). Median percentage of colorectal cancer screening was 39% (IQR 27-51). Percentage of uninsured patients (r = -0.29, p &lt; 0.001) and percentage of patients below 100% of the poverty line (r = -0.24, p &lt; 0.001) were negatively correlated with colorectal cancer screening percentages. Median percentage of cervical cancer screening 48% (IQR 37-59). Percentage of Hispanic patients (r = +0.22, p &lt; 0.001) and percentage of patients for whom English is not their first language (r = +0.29, p &lt; 0.001) were positively correlated with cervical cancer screening percentages. Conclusions: Compared with national averages, patients who are served by FQHCs are less likely to receive recommended breast, colorectal, and cervical cancer screening tests, likely driven by social determinants of health. FQHCs represent trusted healthcare providers who serve high proportions of uninsured, Medicaid, low-income, diverse patients. Health care researchers and practitioners interested in reducing cancer disparities should consider working with FQHCs to conduct targeted outreach initiatives.

Citation Format: Ashley M. Stuckwisch, Anand K. Narayan. Predictors of cancer screening in federally qualified health centers in the United States: A cross sectional study [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR020.