Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston.
Department of Public Health Science, Medical University of South Carolina, Charleston.
JAMA Intern Med. 2024 Jun 1;184(6):671-679. doi: 10.1001/jamainternmed.2024.0693.
Federally qualified health centers (FQHCs) deliver health care to nearly 30 million underserved persons across the US, yet nationwide and state-level breast, cervical, and colorectal cancer screening use in FQHCs is not described. Furthermore, it is unknown how the underscreened FQHC population contributes to the total underscreened population at national and state levels.
To describe national- and state-level breast, cervical, and colorectal cancer screening use among individuals served by FQHCs in the US and to estimate the percentage of underscreened individuals in the general population served by FQHCs.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis of cancer screening used data from January 1 through December 31, 2020, from the FQHC Uniform Data System, reported by 1364 FQHCs across the US, and self-reported estimates from the Behavioral Risk Factor Surveillance System. Participants were 16 696 692 US adults served by FQHCs who were eligible for breast (age, 50-74 years), cervical (age, 21-64 years), and colorectal (age, 50-75 years) cancer screening. Analyses were conducted between January 1 and June 30, 2023.
Breast, cervical, and colorectal cancer screening.
Percentages of breast, cervical, and colorectal cancer screening-eligible individuals up to date on screening.
A total of 3 162 882 breast, 7 444 465 cervical, and 6 089 345 colorectal screening-eligible individuals were served by FQHCs in 2020. Nationally, screening use in FQHCs was 45.4% (95% CI, 45.4%-45.5%) for breast cancer, 51.0% (95% CI, 51.0%-51.1%) for cervical cancer, and 40.2% (95% CI, 40.1%-40.2%) for colorectal cancer. Screening use among the US general population was 78.2% (95% CI, 77.6%-78.9%) for breast cancer, 82.9% (95% CI, 82.3%-83.4%) for cervical cancer, and 72.3% (95% CI, 71.7%-72.8%) for colorectal cancer. The contribution of the underscreened population served by FQHCs to the national underscreened general population was 16.9% (95% uncertainty interval [UI], 16.4%-17.4%) for breast cancer, 29.7% (95% UI, 28.8%-30.7%) for cervical cancer, and 14.7% (95% UI, 14.4%-15.0%) for colorectal cancer.
Findings from this national cross-sectional study indicated major gaps in cancer screening use in FQHCs in the US. Improved prevention is urgently needed to address screening disparities.
联邦合格的健康中心 (FQHC) 为全美近 3000 万服务不足的人群提供医疗服务，但全美和各州的 FQHC 乳腺癌、宫颈癌和结直肠癌筛查使用率并未得到描述。此外，尚不清楚在全国和各州的未接受充分筛查人群中，未接受充分筛查的 FQHC 人群占多大比例。
描述美国 FQHC 服务人群的乳腺癌、宫颈癌和结直肠癌筛查的全国和州级使用率，并估计 FQHC 服务的一般人群中未接受充分筛查的人群比例。
设计、地点和参与者：本横断面分析使用了 2020 年 1 月 1 日至 12 月 31 日期间来自美国各地 1364 家 FQHC 的 FQHC 统一数据系统报告的数据，以及来自行为风险因素监测系统的自我报告估计。参与者为 16696692 名接受 FQHC 服务的美国成年人，有资格接受乳腺癌（年龄 50-74 岁）、宫颈癌（年龄 21-64 岁）和结直肠癌（年龄 50-75 岁）筛查。分析于 2023 年 1 月 1 日至 6 月 30 日进行。
乳腺癌、宫颈癌和结直肠癌筛查。
接受筛查的乳腺癌、宫颈癌和结直肠癌筛查合格人群的比例。
2020 年，共有 316.2882 名乳腺癌、744.465 名宫颈癌和 608.9345 名结直肠癌筛查合格者在 FQHC 接受治疗。在全国范围内，FQHC 的乳腺癌筛查使用率为 45.4%（95%CI，45.4%-45.5%），宫颈癌为 51.0%（95%CI，51.0%-51.1%），结直肠癌为 40.2%（95%CI，40.1%-40.2%）。美国一般人群的乳腺癌筛查使用率为 78.2%（95%CI，77.6%-78.9%），宫颈癌为 82.9%（95%CI，82.3%-83.4%），结直肠癌为 72.3%（95%CI，71.7%-72.8%）。FQHC 服务的未接受充分筛查人群对全国未接受充分筛查的一般人群的贡献为乳腺癌 16.9%（95%不确定区间 [UI]，16.4%-17.4%），宫颈癌 29.7%（95%UI，28.8%-30.7%）和结直肠癌 14.7%（95%UI，14.4%-15.0%）。
这项全国性横断面研究的结果表明，美国 FQHC 癌症筛查的使用率存在重大差距。迫切需要采取改进的预防措施来解决筛查差距。
