New analysis from the Medical University of South Carolina (MUSC) Hollings Cancer Center highlights that federally qualified health centers (FQHCs) remain underutilized in efforts to close gaps in cervical cancer screening (CCS). The findings, published in JAMA Network Open, suggest that expanding CCS in FQHCs could substantially increase the number of women screened and potentially lead to earlier cancer detection and prevention.
Increased screening could meet Healthy People 2030 targets
The study reveals that only 55% of women who visit FQHCs are up to date (UTD) with CCS. If the national target of 79% screening outlined by Healthy People 2030 (HP2030) were achieved, approximately 1.87 million additional women could be screened. This uptick could translate into identifying precancerous changes or cancers at earlier, more treatable stages, thereby reducing morbidity and mortality associated with cervical cancer.
Key findings
- 55% of women at FQHCs are UTD on CCS.
- Reaching HP2030’s 79% target could reach an additional 1.87 million women.
- Improvements in CCS at FQHCs would disproportionately benefit uninsured, low-income, rural, and minority populations.
- Regional gains in UTD CCS rates could range from 1.8% to 2.8% if national targets are met.
- Enhancing CCS in FQHCs may also lower anal cancer risk linked to HPV.
The role of FQHCs in reducing disparities
Dr. Trisha Amboree, PhD, an assistant professor at MUSC, emphasized that FQHCs form the backbone of the nation’s safety-net health system. “Screening and prevention in those settings not only save lives but also save money, preserve quality of life, and support people’s ability to contribute to their families and communities,” she noted.
Methodology and scope
The research aimed to quantify underscreened patients within FQHCs. Data came from the Health Resources and Services Administration Uniform Data System and encompassed 1,352 FQHCs, compared with the general U.S. population from the National Health Interview Survey 2021. CCS eligibility followed United States Preventive Services Task Force guidelines, focusing on individuals aged 21 to 64 with a cervix. UTD CCS was defined as cytology within the last 3 years for ages 21–64, or high-risk HPV testing within the last 5 years for ages 30–64. Individuals with prior hysterectomy were excluded.
Population and service patterns
The analysis included 7,757,211 CCS-eligible patients within a larger pool of 85,364,685 individuals. Among uninsured participants, 18.8% received care at FQHCs, compared with 14.5% of rural residents, 17% of those at or below 200% of the federal poverty level, 12.7% of racial or ethnic minorities, and 24.9% of those who are publicly insured. CCS services at FQHCs were documented in 15.7% of underscreened patients overall, with higher shares among uninsured (19.5%), publicly insured (35.9%), minority groups (17.7%), those at or below 200% of the poverty line (22.4%), and rural residents (26.3%).
Geographic and regional differences
UTD CCS was 55.1% among patients served by FQHCs, compared with 74% in the general U.S. population. Regionally, the Northeast had 16.5% of underscreened patients served by FQHCs, the Midwest 14.1%, the South 13.5%, and the West 19.1%.
Potential impact of meeting HP2030
Modeling suggests a 2.2% national increase in UTD CCS by boosting CCS in FQHCs to 79.2% by 2030, equating to roughly 1.87 million additional screenings. The estimated gains would be most pronounced among uninsured and publicly insured individuals, those below 200% of the poverty line, racial and ethnic minorities, and rural residents—projections of 4.5%, 6%, 4.1%, 3.1%, and 4.4% respectively. Regionally, the Northeast could see a 2.0% rise, the Midwest 1.8%, the South 2.1%, and the West 2.8%.
Next steps and implications
The investigators underscored the potential of targeted strategies within FQHCs to substantially raise CCS rates and reduce cervical cancer disparities. They also noted possible links between cervical cancer screening and lower anal cancer risk, particularly among women aged 65–74 with a prior cervical cancer diagnosis.
Expert commentary
Amboree highlighted that investing in screening accessibility at FQHCs could protect those most in need and yield broader health and economic benefits. The study’s findings support pursuing policy and programmatic efforts to enhance CCS delivery in these safety-net clinics.
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