Abstract C77: Impact of insurance and primary care stability on cancer screening behaviors
Authors: Freund Karen M. , Reisinger Sarah A. , LeClair Amy , Al-Najar Sarah , Young Gregory S. , Oliveri Jill , Gonzalez Evelyn , Paskett Electra 
Published: February 2019

Background: Disparities in rates of cancer screening are observed in racial and ethnic minority, immigrant, low-income, and low-education populations. One of the means by which these vulnerable populations may not receive screening is due to lack of stable health insurance. The goal of the present study is to examine the association between current insurance status, insurance stability, and up-to-date cancer screening in underserved populations.

Methods: As part of the Cancer Disparities Research Network pilot cohort, the study recruited participants across four sites: Boston Chinatown, African American communities in Philadelphia, Hispanic communities in Columbus, and rural white communities in Appalachia, Ohio. Enrolled participants were eligible if they were 40-74 years old, did not live in a nursing home or other facility, and had no prior invasive cancer diagnosis. Additionally, each participant met at least one of the following criteria indicating being medically underserved: living in a medically underserved area, having low literacy, low income (defined as 100% of the 2015 Federal Poverty Level) or being uninsured, having gaps in insurance, or receiving subsidized health insurance coverage.

Participants completed a baseline survey of demographic data, health insurance status, primary care physician (PCP) status, and most recent breast, cervical, and colorectal cancer screenings. Using the USPSTF guidelines, breast cancer screening was considered up to date if women ages 40–74 had a mammogram within the past 2 years. Cervical cancer screenings were up to date if women had a Pap test within the last 3 years or both a Pap test and an HPV test within the last 5 years. Colorectal cancer screening was current if participants had either a colonoscopy within the last 10 years, a flexible sigmoidoscopy within the last 5 years, or a fecal occult blood test (FOBT) within the last year. To assess participants' consistency of coverage, we defined stable insurance coverage as continuous coverage over the prior 12 months, and unstable insurance coverage as being uninsured, losing insurance, or having switches across major insurance categories at any point in the prior 12 months.

Results: Of the 333 participants enrolled in the study, 65.5% were women, 14.1% were 40-50 years of age, 59.8% were 51-64 years, and 26.1% were 65-74. The cohort was racially and ethnically diverse: 8.4% participants identified as Hispanic, 30.3% as non-Hispanic White, 31.2% as non-Hispanic Black, 29.4% as non-Hispanic Asian, and 0.6% as Other. 62.2% spoke English, 8.1% Spanish, and 29.7% Chinese as their primary language. Low incomes were common: 33.6% reported incomes $15,000 or less, and 25.8% reported incomes between $15,000 and $24,999.

Overall self-reported screening rates were 77.9% for breast cancer, 71.1% for cervical cancer, and 67.7% for colorectal cancer. 90.7% of participants reported being currently insured at the time of the interview, and 70% reported stable insurance coverage. Being currently insured was associated with colorectal cancer screenings [69.5% among insured vs. 30.8% among uninsured (p= 0.0059)] but not with breast or cervical cancer screenings. Stable insurance coverage was not statistically associated with up-to-date screenings.

Conclusion: Overall screening rates meet Healthy People 2020 targets for breast cancer, but fall short for cervical and colorectal cancer screening. Rates of insurance are high at 90%, reflecting adoption of Medicaid expansion in all three states. In spite of low income, this population reported being up to date on colorectal cancer screenings if they had current health insurance. The low overall rates of colorectal cancer screening might be related to the lower prevalence of free or low-cost colon cancer screening programs.

Citation Format: Karen M. Freund, Sarah A. Reisinger, Amy LeClair, Sarah Al-Najar, Gregory S. Young, Jill Oliveri, Evelyn Gonzalez, Electra Paskett. Impact of insurance and primary care stability on cancer screening behaviors [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C77.