AI reveals crucial community factors influencing cancer screening rates
A “groundbreaking” new study from the Neiman Health Policy Institute reveals key community factors hindering cancer screening rates.
Over 2 million cancer cases will be diagnosed in the U.S., based on 2024 estimates, leading to more than 600,000 deaths. However, cancer risk is unevenly distributed across the country, experts wrote Thursday in JAMA Network Open.
Neiman researchers recently scoured for factors that might impact screening rates across cancers of the colon/rectum, lung, breast and prostate, using nationwide Medicare data.
“Poverty rate was the most consistently important predictor of community cancer outcomes across cancer types,” Alexandra Drake, MPH, senior analyst at the Neiman Institute and the study’s lead author, said in a statement Oct. 23. “Environmental risks, including air toxics, were also high ranking, as were housing issues and physical inactivity, revealing critical focus areas to maximize public-health impact.”
The study utilized machine learning to estimate the relative impact of 24 different community measures on imaging and cancer mortality. These included health behaviors and lifestyle, socioeconomic issues, and environmental factors. For each cancer type, county-level screening and prevalence rates were based on a nationally representative, 5% Medicare fee-for-service sample, among other sources.
Smoking rate was the No. 1 explanatory community factor for both lung and colorectal cancer, Drake and colleagues found. Meanwhile, black, non-Hispanic race was the top factor for both breast and prostate cancers. When analyzing drivers behind disease prevalence, researchers found the following insights for each cancer type:
- Breast: Uninsured rate was the top influencing factor for disease prevalence, while a community’s Hispanic population had the biggest impact on mammography screening rate.
- Colorectal: Unemployment was the biggest factor for greater disease prevalence, and poverty produced the largest effect on screening.
- Lung: Limited access to healthful foods had the biggest influence on disease prevalence, while air pollution most impacted cancer screening rates.
- Prostate: Poor physical health was the top ranked factor for disease prevalence, and Air Toxics Cancer Risk ranked highest for screening.
Researchers also highlighted notable cancer outcome differences based on geography. Parts of the country were “hotbeds” for cancer risk and worse outcomes, the authors noted. For instance, Texas had the worst breast cancer screening rates and high uninsured rates. Areas around Dallas such as Johnson County were among the worst in the U.S. for both of these measures, the authors noted. Meanwhile, among counties ranking last for smoking and lung cancer mortality, 7 out of 10 were in Kentucky.
The study authors also produced maps to guide cancer screening initiatives. They showed regional patterns producing worse housing problems on the East and West coasts, along with higher cancer prevalence. The rate of severe housing problems, such as overcrowding and high costs, were of “high importance” to cancer prevalence across 3 of the 4 disease types examined.
“This research reveals opportunities for action for health systems,” William Small Jr., MD, with the Loyola Cardinal Bernadin Cancer Center, co-author and advisor to the Neiman maps project, said in a statement. “For example, Loyola Medicine’s patients in the Chicago metro area have high breast cancer prevalence combined with high air pollution compared to other parts of the U.S. At our cancer center, we are using these data to better understand challenges for the populations we serve to plan targeted community outreach efforts to decrease the burden of cancer in specific areas.”
Read much more in the Journal of the American Medical Association, including a corresponding editorial.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.