it Right GETTING
GETTING
IT
How Can We
Screen the Unscreened?
DESPITE ADVANCES IN COLORECTAL CANCER (CRC) SCREENING, FAR TOO MANY INDIVIDUALS ARE NOT BEING SCREENED. The problem is particularly acute at the 1,250 federally qualified
Karen E. Kim, MD, MS Professor of Medicine University of Chicago
health centers (FQHCs) with 8,000 service sites nationwide who provide the highest proportion of primary care to our nation’s most vulnerable and underserved populations. In 2016, FQHCs provided primary care services to more than 25 million patients, 65% being racial/ethnic minority populations and 23% uninsured. Unfortunately, among these vulnerable populations, CRC screening rates at FQHCs are significantly lower at 35% compared with the national average of 62%. There are numerous system- and providerlevel barriers which contribute to these low screening rates including cost, access and poor communication. Many FQHC providers use FOBT/FIT as the initial screening option, but follow-up for those found to have a positive test is often delayed or never results in a completed diagnostic exam. The lack of specialty access for colonoscopy services within our nation’s safety net systems is a significant problem, with the average wait of 18 months to complete a diagnostic colonoscopy. This alone can significantly contribute to disparities in CRC mortality, with studies showing that a one-year delay in follow-up for a positive FIT can lead to a two-fold increase in CRC risk. How can we close this gap to reduce the unnecessary burden of disease?
Getting it Right | 17
