New Research in JNCCN Highlights Dangerous Disparities for Life-Saving Cancer Screening

In In The News by Barbara Jacoby

Study finds more work is needed to enhance adherence to recommended cancer screening in
Canada.

New research in the January 2021 issue of JNCCN—Journal of the National Comprehensive Cancer Network finds more than a third of eligible people miss timely screening tests for colorectal cancer and at least a quarter appear to miss timely screening tests for breast and cervical cancers. The study comes from the University of Alberta, Faculty of Medicine and Dentistry in Alberta, Canada, with findings based on self-reported results from the Canadian Community Health Survey (CCHS) from 2007-2016. According to the author, the results also point to evidence of screening disparities being linked to lower socioeconomic status and identifiable minority race—echoing a similar study conducted in the United States by the Centers for Disease Control.[1]

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“We already have high-quality evidence showing that recommended cancer screening saves lives. From a cost perspective, it is far cheaper to have an efficient cancer screening program and lower cancer-specific mortality than to have a high incidence of advanced incurable cancers that would cost the system much more—not to mention the lost opportunities for healthy, cancer-free individuals to work and contribute to the economy,” said Omar M. Abdel-Rahman Abdelsalam, MBBCh, MSc, MD, Assistant Professor of Medical Oncology, University of Alberta. “These findings show we need more measures to eliminate socioeconomic-related health disparities in our communities, even where healthcare is publicly funded. The most powerful intervention to improve screening rates would be to invest more in primary care and make sure every individual is linked to a family physician who can track their adherence to recommended screening tests.”

Dr. Abdel-Rahman looked at self-reported data for 99,820 people eligible for colorectal cancer screening, 59,724 people eligible for breast cancer screening, and 46,767 in the cervical cancer screening cohort, based on Canadian guidelines from 2007 through 2016. 43% did not have a timely screening test for colorectal, 35% did not have timely mammography, and 25% did not have a timely PAP smear. There were modest increases in screening compliance throughout the study’s duration according to self-reporting within the survey.

“Dr. Abdel-Rahman’s study adds to the literature showing that decreased levels of adherence to common cancer screening practices are associated with social and economic disparities,” commented Mark Helvie, MD, Director, Breast Imaging Division, University of Michigan Rogel Cancer Center, Vice-Chair, NCCN Guidelines® Panel for Breast Cancer Screening and Diagnosis, who was not involved with this research. “Colorectal cancer screening had the lowest compliance with over a third reporting not being screened. While important differences exist between the NCCN Guidelines for screening and the Canadian screening guidelines—especially regarding colonoscopy and initiation and frequency of mammography—they all agree there is a need for more targeted efforts, research, and education to understand and improve compliance among all individuals, as illustrated by this study’s results.”

The research data does not include any impact from the COVID-19 pandemic. However, the publication is particularly timely as doctors report concerning drop-offs of screening numbers, which are projected to possibly result in thousands of excess cancer deaths over the next ten years[2]. The study further highlights how economic and racial disparities contribute to unequal health outcomes and showcases the need for interventions that go beyond coverage for health services alone.

To read the entire study, visit JNCCN.org. Complimentary access to “Patterns and Trend of Cancer Screening in Canada; Results from a Contemporary National Survey” is available until April 10, 2021.

[1] Hall IJ, Tangka FK, Sabatino SA, Thompson TD, Graubard BI, Breen N. Patterns and Trends in Cancer Screening in the United States. Prev Chronic Dis 2018;15:170465. DOI: http://dx.doi.org/10.5888/pcd15.170465

[2] Sharpless, Norman E., COVID-19 and cancer, 2020, https://science.sciencemag.org/content/sci/368/6497/1290.full.pdf

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About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit http://www.nccn.org/jnccn/subscribe.aspx. Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network
The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing educationglobal initiativespolicy, and research collaboration and publication in oncology. Visit NCCN.org for more information and follow NCCN on Facebook @NCCNorg, Instagram @NCCNorg, and Twitter @NCCN.