Relationships Between Health Care Disparities and Coverage Policies for Breast,Colon, and Lung Cancer Screening |
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Authors: | Lincoln L. Berland Debra L. Monticciolo Efren J. Flores Sharp F. Malak Judy Yee Debra S. Dyer |
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Affiliation: | 1. Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama;2. Department of Radiology, Baylor Scott & White Health, Central Texas, Texas A&M University Health Sciences, Temple, Texas;3. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;4. Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas;5. Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York;6. Department of Radiology, National Jewish Health, Denver, Colorado |
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Abstract: | Disparities in outcomes exist for breast, colon, and lung cancer among diverse populations, particularly racial and ethnic underrepresented minorities (URMs) and individuals from lower socioeconomic status. For example, blacks experience mortality rates up to about 42% higher than whites for these cancers. Furthermore, although overall death rates have been declining, the differential access to screening and care has aggravated disparities. Our purpose is to assess how the coverage policies of CMS and the United States Preventive Services Task Force (USPSTF) influence these disparities. Additionally, barriers are often encountered in accessing screening tests and receiving prompt treatment. To narrow, and potentially eliminate, outcomes disparities, CMS and USPSTF could consider revising their decision-making processes regarding coverage. Some options include (1) extending their evidence base to include observational studies that involve groups at higher risk; (2) lowering the threshold ages for screening to encompass differences in incidence; (3) CMS approving screening CT colonography coverage, which can even increase compliance with other screening tests; (4) clarifying and streamlining guidelines; (5) supporting research on improving access to screening; and (6) encouraging the development of more navigation services for URMs. |
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Keywords: | Corresponding author and reprints: Lincoln L. Berland, MD, University of Alabama at Birmingham, Department of Radiology, 3421 Brookwood Trace, Birmingham, AL 35223. Screening mammography CT colonography lung cancer screening health care disparities |
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