Cancer detection to treatment: Health disparities and factors that contribute to them

Despite advances in strategies for cancer prevention and early detection, marked disparities in incidence and mortality in several forms of cancer have persisted and grown. Disparities have been observed across the census tract environment, and recently, during the coronavirus disease 2019 (COVID-19) global pandemic. Such factors, the census tract environment and the COVID-19 pandemic, may create and/or exacerbate existing disparities via impacts on patterns of routine screening and delays in cancer treatment that are not equitably experienced across population subgroups. The objective of the proposed study is to examine research gaps in the cancer prevention continuum and health disparities related to screening and time-to-treatment, specifically for colorectal and cervical cancers. To address this objective, we will leverage data in large population-based cohorts with survey, electronic health records, and administrative data across multiple sites in the US. In Aim 1, we will quantify the associations between area-level colorectal and cervical cancer screening prevalence and the census tract environment. In Aim 2, we will characterize the impacts of the COVID-19 pandemic on the utilization of tests and procedures used for cancer screening and diagnosis by a) comparing the utilization of these tests and procedures before (2019-2020) and during (2020-2021) the COVID-19 pandemic and b) examining whether sociodemographic characteristics and policies related to the COVID-19 pandemic were associated with cancer screening during the pandemic. In Aim 3, we will characterize the relationship with race and ethnicity and socioeconomic factors on diagnosis-to-treatment interval in patients diagnosed with cancer, and its survival effects according to these factors. Findings will inform the allocation of resources and infrastructure changes to both reduce disparities in the future and those widened by events like the COVID-19 pandemic, particularly for disparities not equitably experienced across population subgroups.