Can mammo exams on hospitalized patients help address low screening rates?

July 13, 2021
by Gus Iversen, Editor in Chief
Foregoing recommended cancer screening puts patients at risk of developing a disease that may go undetected until it’s too late. From lack of awareness to lack of opportunity, there are plenty of hurdles that may prevent these exams from taking place. So, if a patient who is due for screening happens to already be hospitalized, why not perform the exam while they’re there?

Researchers at Massachusetts General Hospital asked this very question, and what they found provides reasons to be optimistic. We talked to Dr. Andrew Hwang, lead author and internist, about their results.

HCB News: Earlier this year, you published a study looking at how mammography screening could be performed on hospitalized patients who might not otherwise schedule screening exams. What did you find?
Dr. Andrew Hwang: Our study demonstrates that it is feasible to address preventive care needs, such as breast cancer screening, while patients are hospitalized. This could be an especially important strategy for improving breast cancer screening rates among vulnerable patients who struggle to complete their mammograms in the outpatient setting due to various psychosocial barriers to care. 35% of the women who completed the inpatient screening mammogram never had a screening mammogram before and patients were, on average, four years overdue for their screening.

HCB News: What kind of response did you get from the patients when you offered screening?
AH: While we did not do any follow-up interviews with the inpatient providers or patients to determine the reason why some patients declined screening mammography, it was encouraging to see that 80% of patients who were offered the test were willing to pursue it. A prior study published in the Annals of Family Medicine by Dr. Waseem Khaliq and his colleague at Johns Hopkins found that out of the 250 hospitalized patients who were surveyed, 77% reported that they would be amenable to inpatient screening mammography and 72% of those who were amenable expressed willingness to pay extra money to get the mammogram done.

HCB News: Why did your study look exclusively at Medicare and Medicaid patients?
AH: We targeted patients insured by Medicaid (either Medicaid alone or "dual-eligible" patients who are insured by both Medicare and Medicaid) since data both locally and nationally have demonstrated that these patients have significantly lower breast cancer screening rates compared to patients with commercial insurance.

HCB News: Are there other types of screening that you feel could be implemented into this model of preventive care?
AH: In terms of cancer screening, colon cancer screening using stool-based tests (e.g., Fecal Immunochemical test and Stool DNA test) could be feasible in the inpatient setting since it's noninvasive and would not be too cumbersome for the patient/hospital staff to collect the sample.

HCB News: If these strategies were implemented on a wide, permanent scale, how do you imagine it would impact population health across the country?
AH: These strategies could help reduce long-standing disparities in ambulatory quality outcomes, especially if implemented with a focus on reaching vulnerable patient populations. By breaking down barriers between and acute and preventive care, we could make healthcare more patient-centered and convenient.

HCB News: What do you imagine are some of the key hurdles that stand in the way of combining screening with other inpatient treatments?
AH: One concern from the hospital perspective would be the financial implications of offering additional testing that is not related to the reason for hospitalization. From a health equity standpoint, however, it's important that we commit resources to make care as convenient and accessible as possible for our underserved patients. Also, as our healthcare system transitions from fee-for-service to value-based payment models, improving population health outcomes among underserved patient populations will be increasingly important financially as well.

Another challenge might be inpatient providers being hesitant to order these screening tests if they are worried about patients not getting the appropriate outpatient follow up. Therefore, a robust system must be in place to ensure close follow-up for any abnormal results.