Black and Latino people and those of lower socioeconomic status were more likely to learn they have cancer after an emergency department (ED) visit, suggesting they were not receiving routine care or recommended cancer screenings, according to research presented this week at the American Association for Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.
Screening for breast, cervical, colon, lung and prostate cancer are recommended for at-risk individuals to detect malignancies early, when they are easier to treat. But studies have shown that screening rates are inadequate; for example, only about 2% of eligible current and former smokers have undergone lung cancer screening.
Although ideally diagnosed by general practitioners or oncologists, a substantial portion of cancer diagnoses are made in emergency departments, according to Caroline Thompson, PhD, MPH, an assistant professor of epidemiology at San Diego State University.
In some cases, people visit an emergency room because they are experiencing symptoms of a not-yet-identified cancer. In other cases, cancer is discovered incidentally when people are being treated in the ED for another condition. And some people obtain all their health care from emergency departments because they have no other regular source of care.
“Emergency room detection of cancer provides a window to understanding disparities in receipt of cancer screening and preventive care, since the emergency department sees a disproportionately high number of uninsured, underinsured, lower-income and minority patients,” Thompson said in an AACR press release.
Thompson and colleagues assessed the prevalence of emergency department cancer detection in the United States. Their analysis included more than 415,000 Medicare recipients who were diagnosed with breast, colorectal, lung or prostate cancer between 2004 and 2013. The researchers looked for people who had at least one ED claim in the month before the date of their cancer diagnosis, defined as “ED-mediated” diagnoses.
Overall, 11% of cancer diagnoses were ED-mediated: 5% for breast cancer, 13% for colorectal, 15% for lung and 6% for prostate cancer. People who visited an emergency room shortly before their diagnosis were more likely to be Latino, Black or unmarried and more likely to have a low income. They were also three times more likely to have multiple comorbidities, or coexisting health conditions.
“While some cancers diagnosed in the ED may indicate incidental findings, later-stage symptomatic cancers not identified until they become an emergency may reflect the failure of public health campaigns and primary care services,” the researchers concluded.
“Someone who has a ’screenable’ cancer detected in the emergency department has probably not been screened recently, or ever,” Thompson added. “Screening works, and a routine checkup might alert a primary care provider to subclinical or early-stage disease before it becomes an emergency.”
Thompson acknowledged that because this study focused on Medicare recipients, the results are not generalizable to younger people or those with private insurance or no health coverage. But because Medicare recipients typically have a source of primary care, ED-mediated cancer detection might be even more common among the general public.
“Cancer care episodes that begin in the emergency department are likely to be more resource-intensive and more costly than episodes that start in the primary care setting,” Thompson said. “Reducing emergency presentation of cancer patients may improve patient outcomes and health care system efficiency.”
Click here to read a press release about the study.
Click here to see the conference program.