One would think that a positive result from a screening test indicating the possible presence of cancer would set into motion a host of swift interventions leading to a timely diagnosis and treatment. That is usually what happens. However, there are situations wherein delays are incurred. A need for further diagnostic testing, such as a CT scan or cytology, can extend the time to treatment initiation.
Any delay can increase the chance of disease progression and worse outcomes. In this study, Chyke Doubeni, MD, PhD, chair of Family Medicine and Community Health at the Perelman School of Medicine at the University of Pennsylvania, and colleagues sought to determine how the time interval from screening to diagnosis affects some cancer outcomes. Their literature review identified studies published between January 1998 and December 2017.
An Unmet Healthcare Priority
According to the National Academy of Medicine (formerly the Institute of Medicine), important health care priorities have not been met in this country, such as timeliness and patient-centered care. Screening is one of these health care priorities that has successfully reduced the risk of death from lung, breast, cervical, and colorectal cancers. Consequently, the US Preventive Services Task Force (USPSTF) recommends timely screening as an important component of patient-centered care at grade A or B, thus enabling full coverage of those services under the Affordable Care Act. However, even though it is covered for many patients, screening by itself is not sufficient to secure a diagnosis and set a treatment plan. This is the crux of the problem: positive screening results must be followed-up with diagnostic tests as soon as possible.
Although follow-up evaluation and diagnostic testing are essential for guiding clinical decisions after a positive screening result, the timing of these intervals varies depending on the cancer type. Sometimes diagnostic testing is delayed by fluctuations in insurance coverage or something mundane such as a change in the patient’s contact information. Dr Doubeni and colleagues found that the longer patients wait for follow-up and diagnosis to take place, the less likely they are to undergo diagnostic testing.
The ideal timing for follow-up testing to confirm the presence and severity of cancer is not established; however, there are advantages to pursuing positive screenings as quickly as possible. Of course, as the follow-up is delayed the cancer can progress from precancerous or more curable lesions to less curable disease. Faster follow-up can mean a more accurate diagnosis and fewer worries for the patient about what type of procedure lies ahead.