Why FQHCs are key to boosting cervical cancer screening rates

Patients with cervical cancer screening gaps visit FQHCs

It's not uncommon for a patient visiting an FQHC to have a lapse in a cancer screening, the study found.

Focusing specifically on cervical cancer screening rates at 1,352 FQHCs serving nearly 8 million people across the United States, the team found that sizeable proportions of patients are in need of a cervical cancer screening.

For example, FQHCs served 35.9% of publicly insured individuals and 19.5% of uninsured individuals in need of a cervical cancer screening.

FQHCs also served 26.3% of individuals living in rural regions needing cervical cancer screening, as well as 22.4% of unscreened low-income individuals living at or below 200% of the federal poverty level.

Finally, FQHCs serve 17.7% of unscreened people from racial or ethnic minority groups.

FQHCs could help boost national cervical cancer screening rates

These findings demonstrate the role FQHCs could play in closing care gaps nationwide, the researchers said.

If FQHCs were able to close the cervical cancer screening gaps to benchmarks spelled out in Healthy People 2030 (79.2% screening rate), it would make a significant dent in overall cancer screening rates nationwide.

"Although these improvements alone may not achieve the [Healthy People 2030] target, strategic investment in preventive services at FQHCs could substantially advance progress, particularly for underserved populations," the researchers said.

But increasing cervical cancer screening rates at FQHCs isn't that simple. Typically, FQHCs need to co-test for high-risk HPV when they do cervical cancer screenings, which can strain capacity, cost, competing healthcare needs and patient willingness to undergo more invasive examination.

The researchers suggested providing more opportunities for self-collection cervical cancer screenings, plus promoting patient education and care navigation.

But those don't come without their costs, the researchers acknowledged.

"Collectively, investment in the integration of self-collection and the provision of enabling services could provide a tangible way to address low CCS rates in FQHCs," the researchers explained. "However, sustained investment in FQHCs may be affected by evolving health care policies and changes in funding streams, including support for Medicaid and the [Health Resources and Services Administration]."

FQHC funding is a complicated matter

Funding for community health centers and FQHCs is always complex, with lobbying groups such as the National Association of Community Health Centers (NACHC) regularly calling for Congress to extend funding.

At present, the government shutdown complicates matters further.

FQHCs and community health centers are known for operating on razor-thin margins, and their mandatory and discretionary funding both expired on September 30, according to NACHC. Some community health centers had enough money to get them through a period of the shutdown, but with no end in sight, that cashflow could soon cease.

In other words, FQHCs and community health centers are facing challenges funding their typical operations, let alone special initiatives to close cancer screening gaps.

In the long term, however, it will be important for policymakers to consider the role safety-net clinics can play in achieving the nation's health goals. By providing monetary support for FQHCs working to close cancer screening gaps, they can make improvements in the currently dismal national cancer screening rates.

Sara Heath has reported news related to patient engagement and health equity since 2015.