Improving Cancer Detection, Screening Uptake in Community Oncology: Constance Blunt, MD

Improvements in early detection of breast and colorectal cancers can be attributed to increased access due to Medicaid expansion, says Constance Blunt, MD, medical oncologist, Mary Bird Perkins Cancer Center.

This transcript was lightly edited; captions were auto-generated.

Transcript

Since the Affordable Care Act requirement for preventive screenings took effect about a decade ago, have patients with certain cancers been diagnosed earlier than in the years before the requirement?

We've noticed a trend for several decades that overall, early detection or earlier diagnosis of multiple cancer types was improving, and that has translated into an overall improvement of survival for cancer patients. A big part of that is early detection. We have seen an increase in early detection in Louisiana and within our organization at Mary Bird Perkins. Two common tumor types are both breast and colorectal. For the patients that are coming in to get screened, most of those cases are being diagnosed very early-stage or where we have just regional disease. A minority of those cases, fewer of those cases are patients who have metastatic disease, and that's huge. The earlier we diagnose a cancer, the more likely we are to be able to give someone curative intent treatment, and that's where we get that bigger survival benefit. We have definitely seen an increase in early detection, and that's partly because these patients have access to be able to get in and get these preventative things done.

Did you see any additional uptick once Louisiana added Medicaid expansion?

Uptake across multiple tumor types, specifically breast, colorectal, and even lung. Lung is probably where we see a big impact, partly because we now have comprehensive lung cancer screening recommendations, and again, we have access to get large populations of people early screenings.

Can you tell us about the Prevention on the Go program?

At Mary Bird Perkins, at the core of what we do, cancer prevention and saving lives is at the root of all of that. This Prevention on the Go Program seeks to bring cancer screenings, patient education, even primary care resources to communities that have limited access. We know that even a small financial inconvenience or a small travel to a patient can mean the difference between not having a doctor's appointment and actually being able to make that appointment. By taking our mobile services and our collaborative relationships with providers across the region, we are in people's workplaces. We are in their community. We are at their churches.

With a phone call or just a simple visit to one of our mobile events, patients are now signed up for age-appropriate screenings. They are diverted to primary care service and other resources to help, for lot of patients, start their health journey or fill in the gaps of things that they were unable to get done in their own communities. There's an area in Louisiana where a gastroenterologist left, found a new job and moved for whatever reason, and there was no one else available in that region to provide those screening colonoscopies, and so we saw a decline in how many patients were getting colonoscopies. That's a big deal. Just one provider change or one clinic move, can really stop access for a larger group of people.

Through our partnerships, when we find these patients in the community, and we're doing health screenings, we're checking vital signs, we're getting them set up for their mammogram or their colonoscopy, if you don't have a primary care doctor, we kind of tell you, "Well, these are the things that you need to be looking for.” We help patients find physicians that are closer to their home or that accept their insurance or that are available to take appointments. It's not just about cancer screening; it's about the entire preventative care spectrum. Those partnerships have been really, really crucial. Sometimes, through repeated interactions or repeated referrals to a doctor, it's now just a phone call, you pick up the phone, “Hey, I need this.” It's easier for patients to get the care that they need through these relationships and ongoing collaborations.