Gaps in care across the cancer screening continuum for cervical, colorectal, and lung cancers.

Abstract

Screening for cervical, colorectal, and lung cancers reduces cancer-specific mortality, but the full benefits of screening are realized only when they are coupled with timely care across the subsequent "screening continuum" steps, including surveillance (results warranting frequent monitoring), diagnostic evaluation (results that require additional testing), and treatment (detected cancers). Our goal was to describe the proportion of individuals receiving timely cervical, colorectal, and lung cancer care at each step in the screening continuum. This retrospective cohort study used data from the 10 health-care settings that participate in the Population-based Research to Optimize the Screening Process, 2018 to present, consortium and included individuals who were eligible for a step along the cancer screening continuum in 2018. Proportions of individuals who received timely testing were calculated for screening, surveillance, and diagnostic tests for each of the 3 cancers and treatment (colorectal cancer only), and we evaluated the association of these outcomes with patient characteristics using multivariate logistic regression. The overall proportions of timely screening, surveillance, and diagnostic testing were 41.8%, 37.3%, and 61.2% for cervical cancer; 82.4%, 45.5%, and 73.5% for colorectal cancer (94.1% for timely treatment); and 73.8%, 80.5%, and 80.7% for lung cancer. Across all 3 cancers, there were differences across the screening continuum by insurance status, race and ethnicity, and socioeconomic status. There are important gaps in care across the screening continuum beyond common metrics for screening uptake. Comparison across organ types may facilitate the identification of interventions and policies that could broadly improve cancer prevention and promote health equity.