Gaps in care across the cancer screening continuum for cervical, colorectal and lung cancer.

BACKGROUND While screening for cervical, colorectal, and lung cancers reduce cancer-specific mortality, the full benefits of screening are only realized when coupled with timely care across the subsequent "screening continuum" steps, including surveillance (results warranting frequent monitoring), diagnostic evaluation (results that require additional testing), and treatment (detected cancers). Our goal was to describe the proportion of individuals receiving timely cervical, colorectal, and lung cancer care at each step in the screening continuum. METHODS This retrospective cohort study used data from the 10 health care settings that participate in the Population-based Research to Optimize the Screening Process (PROSPR II) consortium and included individuals who were eligible for a step along the cancer screening continuum in 2018. Proportions of individuals who received timely testing were calculated for screening, surveillance, and diagnostic tests for each of the three cancers and treatment (colorectal only), and the association of these outcomes with patient characteristics was evaluated using multivariate logistic regression. RESULTS The overall proportions of timely screening, surveillance, and diagnostic testing were 41.8%, 37.3%, and 61.2%, for cervical cancer; 82.4%, 45.5%, and 73.5% for colorectal (94.1% for timely treatment); and 73.8%, 80.5%, and 80.7% for lung cancer. Across all three cancers, there were differences across the screening continuum by insurance status, race/ethnicity, and socioeconomic status. CONCLUSIONS There are important gaps in care across the screening continuum beyond common metrics for screening uptake. Comparison across organ types may facilitate the identification of interventions and policies that could broadly improve cancer prevention and promote health equity.