School of Medicine and Health Sciences Poster Presentations

Title

Cancer Screening Rates in the Bridge to Care Student-Run Free Clinic Population of Prince George's County Maryland

Poster Number

301

Document Type

Poster

Status

Medical Student

Abstract Category

Prevention and Community Health

Keywords

community health, preventative care, underserved medicine

Publication Date

Spring 2018

Abstract

Background: Breast, colon, and cervical cancer screening reduce morbidity and mortality. Cancer screening in underserved communities is lower than national averages leading to increased incidence and mortality in this population. GWSMHS’s student-run free Healing Clinic site in Prince George’s County, Maryland is thought to have a largely uninsured and Hispanic, population. It has the ability to perform pap smears on site. There are 5 known referral clinics for breast cancer screening, and 1 known referral clinic for colorectal cancer screening. Formal assessment of the clinic’s demographics and cancer screening rates are crucial to decrease health disparities and improve the health of the Bridge to Care clinic population.

Methods: A 10-item questionnaire was verbally administered in English or Spanish to each participant by a member of the research team in a private area of clinic. Telephone interpretation provided through Globo was utilized for some Spanish speakers and all other non native-English speakers. The questionnaire screened for previous mammography in the last 2 years, Pap smear in the last 3 and 5 years, fecal occult blood test in the last year, and colonoscopy in the last 5 and 10 years. Inclusion criteria were based on the 2016 breast, 2012 cervical, & 2008 colorectal USPSTF cancer screening guidelines. Participants were deemed eligible if current age met screening criteria or if age at last screening met criteria.

Results: There were 39 total participants, of which 56% were male, 44% female; 67% were Hispanic, 31% African American, and 3% Asian. The population had an average age of 49.5, SD 14.1. 11, 20 and 14 patients were eligible for breast, cervical and colorectal cancer screening respectively. 5/11 eligible patients had been referred for mammogram, 3/11 from Bridge to Care, 2/11 from outside clinics. 60% of referred patients had a mammogram. 14/20 eligible patients had a pap smear, 10/20 from Bridge to Care, 4/20 from another clinic. 4/14 eligible patients had a colonoscopy, all referred from outside clinics.

Conclusions: Cervical cancer had the highest rate of screening. All screening rates were lower than PG County and National averages. Cervical cancer screening approached national averages, 70% versus 83%, likely given pap smears can be done in clinic. Further research into patient demographics and screening rates are needed for a statistically significant sample. We recommend investigating screening barriers such as distance from referral site, insurance, citizenship, and culture, which might contribute to lower rates of cancer screening at BTC.

Resources:

1.American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2015-2016. Atlanta: American Cancer Society; 2015

2.Calle EE, Flanders WD, Thun MJ, Martin LM. Demographic predictors of mammography and Pap smear screening in US women. American Journal of Public Health. 1993;83(1):53-60. doi:10.2105/ajph.83.1.53.

3.Elewonibi BR, Thierry AD, Miranda PY. Examining Mammography Use by Breast Cancer Risk, Race, Nativity, and Socioeconomic Status. Journal of Immigrant and Minority Health. 2016. doi:10.1007/s10903-016-0502-3.

4.Final Update Summary: Cervical Cancer: Screening. U.S. Preventive Services Task Force. September 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening

5.Grubb MCMD, Kilbourne B, Zoorob R, Gonzalez S, Mkanta W, Levine R. Resident Physicians and Cancer Health Disparities: a Survey of Attitudes, Knowledge, and Practice. Journal of Cancer Education. 2015;31(3):541-546. doi:10.1007/s13187-015-0846-8.

6.Hu ZI, and Smith DM. Cancer Screening Rates in a Student Run Free Clinic. Ochsner Journal. 2016;16 (1):37–40,

7.Roetzheim, Richard G., et al. “Effects of Health Insurance and Race on Early Detection of Cancer | JNCI: Journal of the National Cancer Institute | Oxford Academic.” OUP Academic, Oxford University Press. 1999. academic.oup.com/jnci/article/91/16/1409/2543802/Effects-of-Health-Insurance-and-Race-on-Early.

8.Siu, Albert L. “Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement.” Annals of Internal Medicine, vol. 164, no. 4, Dec. 2016, p.

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Cancer Screening Rates in the Bridge to Care Student-Run Free Clinic Population of Prince George's County Maryland

Background: Breast, colon, and cervical cancer screening reduce morbidity and mortality. Cancer screening in underserved communities is lower than national averages leading to increased incidence and mortality in this population. GWSMHS’s student-run free Healing Clinic site in Prince George’s County, Maryland is thought to have a largely uninsured and Hispanic, population. It has the ability to perform pap smears on site. There are 5 known referral clinics for breast cancer screening, and 1 known referral clinic for colorectal cancer screening. Formal assessment of the clinic’s demographics and cancer screening rates are crucial to decrease health disparities and improve the health of the Bridge to Care clinic population.

Methods: A 10-item questionnaire was verbally administered in English or Spanish to each participant by a member of the research team in a private area of clinic. Telephone interpretation provided through Globo was utilized for some Spanish speakers and all other non native-English speakers. The questionnaire screened for previous mammography in the last 2 years, Pap smear in the last 3 and 5 years, fecal occult blood test in the last year, and colonoscopy in the last 5 and 10 years. Inclusion criteria were based on the 2016 breast, 2012 cervical, & 2008 colorectal USPSTF cancer screening guidelines. Participants were deemed eligible if current age met screening criteria or if age at last screening met criteria.

Results: There were 39 total participants, of which 56% were male, 44% female; 67% were Hispanic, 31% African American, and 3% Asian. The population had an average age of 49.5, SD 14.1. 11, 20 and 14 patients were eligible for breast, cervical and colorectal cancer screening respectively. 5/11 eligible patients had been referred for mammogram, 3/11 from Bridge to Care, 2/11 from outside clinics. 60% of referred patients had a mammogram. 14/20 eligible patients had a pap smear, 10/20 from Bridge to Care, 4/20 from another clinic. 4/14 eligible patients had a colonoscopy, all referred from outside clinics.

Conclusions: Cervical cancer had the highest rate of screening. All screening rates were lower than PG County and National averages. Cervical cancer screening approached national averages, 70% versus 83%, likely given pap smears can be done in clinic. Further research into patient demographics and screening rates are needed for a statistically significant sample. We recommend investigating screening barriers such as distance from referral site, insurance, citizenship, and culture, which might contribute to lower rates of cancer screening at BTC.

Resources:

1.American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2015-2016. Atlanta: American Cancer Society; 2015

2.Calle EE, Flanders WD, Thun MJ, Martin LM. Demographic predictors of mammography and Pap smear screening in US women. American Journal of Public Health. 1993;83(1):53-60. doi:10.2105/ajph.83.1.53.

3.Elewonibi BR, Thierry AD, Miranda PY. Examining Mammography Use by Breast Cancer Risk, Race, Nativity, and Socioeconomic Status. Journal of Immigrant and Minority Health. 2016. doi:10.1007/s10903-016-0502-3.

4.Final Update Summary: Cervical Cancer: Screening. U.S. Preventive Services Task Force. September 2016. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening

5.Grubb MCMD, Kilbourne B, Zoorob R, Gonzalez S, Mkanta W, Levine R. Resident Physicians and Cancer Health Disparities: a Survey of Attitudes, Knowledge, and Practice. Journal of Cancer Education. 2015;31(3):541-546. doi:10.1007/s13187-015-0846-8.

6.Hu ZI, and Smith DM. Cancer Screening Rates in a Student Run Free Clinic. Ochsner Journal. 2016;16 (1):37–40,

7.Roetzheim, Richard G., et al. “Effects of Health Insurance and Race on Early Detection of Cancer | JNCI: Journal of the National Cancer Institute | Oxford Academic.” OUP Academic, Oxford University Press. 1999. academic.oup.com/jnci/article/91/16/1409/2543802/Effects-of-Health-Insurance-and-Race-on-Early.

8.Siu, Albert L. “Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement.” Annals of Internal Medicine, vol. 164, no. 4, Dec. 2016, p.