Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana.
West J Emerg Med. 2022 Aug 11;23(5):739-745. doi: 10.5811/westjem.2022.5.55351.
A suspected diagnosis of cancer through an emergency department (ED) visit is associated with poor clinical outcomes. The purpose of this study was to explore the rate at which ED patients attend cancer screenings for lung, colorectal (CRC), and breast cancers based on national guidelines set forth by the United States Preventive Services Task Force (USPSTF).
This was a prospective cohort study. Patients were randomly approached in the Eskenazi Hospital ED between August 2019-February 2020 and were surveyed to determine whether they would be eligible and had attended lung, CRC, and breast cancer screenings, as well as their awareness of lung cancer screening with low-dose computed tomography (LDCT). Patients who were English-speaking and ≥18 years old, and who were not critically ill or intoxicated or being seen for acute decompensated psychiatric illness were offered enrollment. Enrolled subjects were surveyed to determine eligibility for lung, colorectal, and breast cancer screenings based on guidelines set by the USPSTF. No cancer screenings were actually done during the ED visit.
A total of 500 patients were enrolled in this study. More participants were female (54.4%), and a majority were Black (53.0%). Most participants had both insurance (80.2%) and access to primary care (62.8%). Among the entire cohort, 63.0% identified as smokers, and 62.2% (140/225) of the 50- to 80-year-old participants qualified for lung cancer screening. No patients were screened for lung cancer in this cohort (0/225). Only 0.6% (3/500) were aware that LDCT was the preferred method for screening. Based on pack years, 35.5% (32/90) of the patients who were 40-49 years old and 6.7% (6/90) of those 30-39 years old would eventually qualify for screening. Regarding CRC screening, 43.6% (218/500) of the entire cohort was eligible. However, of those patients only 54% (118/218) had been screened. Comparatively, 77.7% (87/112) of the eligible females had been screened for breast cancer, but only 54.5% (61/112) had been screened in the prior two years.
Many ED patients are not screened for lung/colorectal/breast cancers even though many are eligible and have reported access to primary care. This study demonstrates an opportunity and a need to address cancer screening in the ED.
通过急诊部（ED）就诊疑似癌症诊断与临床结局不佳相关。本研究的目的是根据美国预防服务工作组（USPSTF）制定的国家指南，探讨 ED 患者根据国家指南进行肺癌、结直肠癌（CRC）和乳腺癌筛查的比率。
这是一项前瞻性队列研究。2019 年 8 月至 2020 年 2 月期间，在 Eskenazi 医院 ED 随机接触患者，并对其进行调查，以确定他们是否符合条件并接受了肺癌、CRC 和乳腺癌筛查，以及他们对低剂量计算机断层扫描（LDCT）筛查肺癌的认识。纳入标准为：年龄在 18 岁及以上、英语流利、病情未处于危急或中毒状态、或并非因急性失代偿性精神疾病就诊的患者。纳入的患者接受调查，以确定他们是否符合 USPSTF 制定的肺癌、结直肠癌和乳腺癌筛查指南。在 ED 就诊期间并未进行任何癌症筛查。
本研究共纳入 500 名患者。参与者中女性（54.4%）居多，大多数为黑人（53.0%）。大多数参与者均有保险（80.2%）和初级保健（62.8%）。在整个队列中，63.0%的参与者为吸烟者，50-80 岁的参与者中有 62.2%（140/225）符合肺癌筛查条件。本队列中未进行肺癌筛查（0/225）。仅有 0.6%（3/500）的患者知晓 LDCT 是筛查的首选方法。根据吸烟包年数，40-49 岁的患者中有 35.5%（32/90）和 30-39 岁的患者中有 6.7%（6/90）最终将符合筛查条件。关于 CRC 筛查，整个队列中有 43.6%（218/500）的患者符合条件。然而，这些患者中只有 54%（118/218）接受了筛查。相比之下，77.7%（87/112）符合条件的女性已接受乳腺癌筛查，但只有 54.5%（61/112）在过去两年内接受了筛查。
尽管许多 ED 患者有资格接受初级保健，但许多患者并未接受肺癌/结直肠癌/乳腺癌筛查。本研究表明，在 ED 中进行癌症筛查的机会和需求。
