TY - JOUR
T1 - Cervical cancer burden and opportunities for prevention in a safety-net healthcare system
AU - Pruitt, Sandi
AU - Werner, Claudia L.
AU - Borton, Eric K.
AU - Sanders, Joanne M.
AU - Balasubramanian, Bijal A.
AU - Barnes, Arti
AU - Betts, Andrea C.
AU - Skinner, Celette S
AU - Tiro, Jasmin A
N1 - Funding Information:
The authors thank Dr. Noel Santini and colleagues at Parkland Health and Hospital System for supporting our PROSPR research initiatives. We also want to acknowledge the contributions of Mark Burkart for his programming expertise. This study was conducted as part of the NCI-funded consortium, Population-based Research Optimizing Screening through Personalized Regimens (PROSPR; U54CA163308-S1). Additional support provided by the UTSW Center for Translational Medicine, through the NIH/National Center for Advancing Translational Sciences (UL1TR001105) and the Harold C. Simmons Comprehensive Cancer Center (1P30 CA142543). A.C. Betts is supported by a predoctoral fellowship, University of Texas School of Public Health Cancer Education and Career Development Program (NCI/NIH grant R25 CA57712).
Publisher Copyright:
© 2018 American Association for Cancer Research.
PY - 2018/12
Y1 - 2018/12
N2 - Background: The high prevalence of cervical cancer at safety-net health systems requires careful analysis to best inform prevention and quality improvement efforts. We characterized cervical cancer burden and identified opportunities for prevention in a U.S. safety-net system. Methods: We reviewed tumor registry and electronic health record (EHR) data of women with invasive cervical cancer with ages 18þ, diagnosed between 2010 and 2015, in a large, integrated urban safety-net. We developed an algorithm to: (i) classify whether women had been engaged in care (1 clinical encounter between 6 months and 5 years before cancer diagnosis); and (ii) identify missed opportunities (no screening, no follow-up, failure of a test to detect cancer, and treatment failure) and associated factors among engaged patients. Results: Of 419 women with cervical cancer, more than half (58%) were stage 2B or higher at diagnosis and 40% were uninsured. Most (69%) had no prior healthcare system contact; 47% were diagnosed elsewhere. Among 122 engaged in care prior to diagnosis, failure to screen was most common (63%), followed by lack of follow-up (21%), and failure of test to detect cancer (16%). Tumor stage, patient characteristics, and healthcare utilization differed across groups. Conclusions: Safety-net healthcare systems face a high cervical cancer burden, mainly from women with no prior contact with the system. To prevent or detect cancer early, community-based efforts should encourage uninsured women to use safety-nets for primary care and preventive services. Impact: Among engaged patients, strategies to increase screening and follow-up of abnormal screening tests could prevent over 80% of cervical cancer cases.
AB - Background: The high prevalence of cervical cancer at safety-net health systems requires careful analysis to best inform prevention and quality improvement efforts. We characterized cervical cancer burden and identified opportunities for prevention in a U.S. safety-net system. Methods: We reviewed tumor registry and electronic health record (EHR) data of women with invasive cervical cancer with ages 18þ, diagnosed between 2010 and 2015, in a large, integrated urban safety-net. We developed an algorithm to: (i) classify whether women had been engaged in care (1 clinical encounter between 6 months and 5 years before cancer diagnosis); and (ii) identify missed opportunities (no screening, no follow-up, failure of a test to detect cancer, and treatment failure) and associated factors among engaged patients. Results: Of 419 women with cervical cancer, more than half (58%) were stage 2B or higher at diagnosis and 40% were uninsured. Most (69%) had no prior healthcare system contact; 47% were diagnosed elsewhere. Among 122 engaged in care prior to diagnosis, failure to screen was most common (63%), followed by lack of follow-up (21%), and failure of test to detect cancer (16%). Tumor stage, patient characteristics, and healthcare utilization differed across groups. Conclusions: Safety-net healthcare systems face a high cervical cancer burden, mainly from women with no prior contact with the system. To prevent or detect cancer early, community-based efforts should encourage uninsured women to use safety-nets for primary care and preventive services. Impact: Among engaged patients, strategies to increase screening and follow-up of abnormal screening tests could prevent over 80% of cervical cancer cases.
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U2 - 10.1158/1055-9965.EPI-17-0912
DO - 10.1158/1055-9965.EPI-17-0912
M3 - Article
C2 - 30185535
AN - SCOPUS:85057764432
VL - 27
SP - 1398
EP - 1406
JO - Cancer Epidemiology Biomarkers and Prevention
JF - Cancer Epidemiology Biomarkers and Prevention
SN - 1055-9965
IS - 12
ER -