Cancer Screening and Health Disparities – A Catalyst for Change with Dr. Otis Brawley

Introduction

There seems to be no doubt left among healthcare professionals on the benefits that cancer screening can bring to the table. Whether its clinical applications, telehealth systems, or medical imaging, the solutions range across the board. Every hospital now knows that screening is the answer to the challenge of staying ahead of the disease. The number of vendors that offer cancer screening solutions are numerous and their effects come with the potential to transform treatment across medical practices of variant sizes. Is there such a thing as over-screening? Let’s find out.

Screening Versus Educating

Compared to the average global health statistic, cancer stands out as a leading example due to the extensive amount of screening involved. However, the mortality rate of cancer is still quite high. The current popularity of cancer screening is taking precedence over the educational aspects of preventing the disease. Very little effort and time is deployed toward assessing risk behaviors and thereafter educating populations to prevent diseases. A prudent way to address the current scenario would be to undertake wise screening efforts and replace efforts of over-screening, towards risk behavior assessment.  

A recent study revealed that the death rate among college-educated women was almost half than that of high school-educated women. This is a clear indication of the benefits of education towards reducing mortality rates. Awareness is everything.

Cervical Cancer

With cervical cancer, recent studies show that about 4,000 women are going to succumb to cervical cancer this year. Over 90% of these women have had no screening for cervical cancer within the 10-year range of their diagnosis, with the majority having never done the cervical cancer screening. On the flip side, majority of women in the U.S. are undertaking cervical cancer screening, every year, without any recommendation from healthcare organizations to do the same. As a replacement to this over-screening phenomenon, it would be wise to undertake screening among those women who are prone to the disease, due to their social conditions and other factors. This would require efforts to educate the ‘at risk’ populace.  

Prostate Cancer

With prostate cancer, studies have not been able to prove that screenings are successful in saving lives. Most healthcare organizations agree that screening for prostate cancer is not required. Instead, men should be educated about the potential risks and benefits of screening and encouraged to decide independently. More importantly, an overall risk behavior education would serve much more beneficial. Healthcare organizations could put their time and effort to much better use if they explored innovative ways to educate, rather than screen. 

Investing in Healthier Behavior

To shift focus from screening to healthy behaviors, the incentives must shift too. Prevention strategies must be incentivized, more so than screening systems. The traditional mindset, where we were taught to treat cancer, by catching it early, must be changed to a modern approach. An approach that looks at prevention strategies. A powerful tool for the healthcare sector is to educate patients and identify cancers that need to be treated, and those that need to be watched. The difference is crucial.  

The healthcare sector needs to invest in technology, studies, educational strategies, and tests to identify the difference between cancers that need to be treated and those that need to be watched. This is the crucial difference and one where technology needs to be applied. One area that seems promising is liquid biopsy and molecular tests that offer probability statistics. The GRAIL test is slowly gaining momentum across the globe, but it is not being replaced with the option of screening. The hope is that tests, such as GRAIL, will be able to successfully differentiate between cancers that need to be treated versus those that need to be watched.  

The Affordable Care Act

When it comes to the question of over-screening, it seems absurd that there is still a lack of screening among the population health that are potentially at risk. This is where the Affordable Care Act comes into play and the healthcare sector will see its full potential shortly. There is great promise for this reform to reduce the cancer mortality rate as well. Health disparity can be successfully addressed by extending Medicaid and the difference is visible across states that have adopted this policy, versus those that haven’t.  

In many cases, we have a positive cancer diagnosis, but the patients have no access to immediate treatments. The focus needs to be equally distributed across prevention, screening and treatment. The real health disparity is that the current health system has made efforts toward creating opportunities for affordable care, but accessibility and utilization is still not as efficiently applied. Again, education and support come into play. One way would be to apply funds toward social workers who can make caregiving and care programs more accessible.

Cancer Drug Pricing 

Drug pricing is a critical concern across healthcare organizations. If the pricing is high, patients are repulsed, if it is too low, it turns into a hindrance toward the development of new treatments. Insurance policies can help, but there needs to be a more dynamic solution. The common perception is that pharmaceutical companies are pulling in massive profits, due to high pricing. Surprisingly though, insurance companies are overtaking drug companies with higher profits. This requires a keen analysis of the basic structuring of insurance policies.

Conclusion 

Cancer awareness can be created through innovative health education policies. Social issues can be overcome with appropriate policies. Cancer screening is definitely a boon. The critical terms, though, are appropriate screening and appropriate care. A sensible strategy towards preventing, testing, and treating can go a long way in reforming care-giving approach towards cancer, and offering sustainable results. Explore more interesting topics and listen to insightful podcasts related to healthcare only on CareTalk.