Association for Public Policy Analysis & Management

Background: Early detection through screening is the most important predictor of cancer prognosis. Additionally, diagnosing cancer at an early stage can significantly improve the quality of life, lower mortality and reduce treatment costs. Although overall screening rates have improved, there remains a gap in achieving the Healthy People 2020 goals for cancer screening targets, especially among racial and ethnic minorities. Healthcare providers play a crucial role in promoting positive health behaviors. It is known that optimal alignment of characteristics such as race/ethnicity and sex between patient and provider may encourage compliance with treatment due to improved communication. But it remains unclear if concordance plays a role in adherence to cancer screening and can mitigate disparities.

Objective: This study’s objective is to examine if race/ethnicity and sex concordance between a patient and their provider is associated with compliance for breast, cervical and colorectal cancer screening.

Methods: Analyses data are adult respondents with a usual source of care (N = 25,742) identified from annual pooled samples of the 2008-2013 Medical Expenditure Panel Survey. Measures examined were compliance with sex-neutral (colorectal cancer /CRC screening) and sex-specific (mammography and cervical) cancer screening) tests based on the U.S. Preventive Services Task Force screening recommendations. Concordance was categorized as no concordance, race only, sex only or dual concordance using respondents’ report of their own and their providers’ race/ethnicity and sex. Logistic regressions examined association between concordance and screening.

Results: Majority (38%) reported race concordance compared to 16% sex and 18% dual concordance with their provider. Women with female providers were more likely to report adherence to mammography [average adjusted marginal effect (ME) = 8.1%, 95% confidence interval (CI): 4.7%, 11.4%; p<0.001] and cervical cancer screening [ME = 5.1%, 95% CI: 2.5%, 7.6%; p<0.001].Dual concordance also increased the likelihood of reporting mammography [ME = 5.6%, 95% CI: 2.6%, 8.7%; p<0.001] and cervical cancer screening [ME = 4.1%, 95% CI: 1.5%, 6.6%; p=0.002]. Neither sex nor dual
concordance was associated with CRC screening. Race concordance was not statistically associated with increase in screening compliance.

Conclusions: Association between sex concordance with mammogram and cervical cancer screening suggests that either female providers are more likely to recommend them because of better attunement to female preventive needs or patients are more comfortable receiving them from female providers. Limited benefit of concordance on CRC screening could be because it is gender-neutral. There is stronger evidence supporting receipt of CRC screening in presence of shared- decision making and is likely that effective patient-provider communication extends beyond alignment of demographics. The finding that race concordance alone was not associated with screening suggests that while it is worthwhile to ensure more diversity in healthcare workforce, matching patients and providers only on race/ethnicity is unlikely to mitigate disparities in cancer screening.