A new national study, led by MUSC Hollings Cancer Center researcher Trisha Amboree, Ph.D. , assistant professor in the MUSC Department of Public Health Sciences, and Jane Montealegre, Ph.D. , associate professor of Behavioral Science at The University of Texas (UT) MD Anderson Cancer Center, points to federally qualified health centers (FQHCs) as a powerful – but underused – resource in closing gaps in cervical cancer screening.
"FQHCs are the backbone of the nation's safety net health system," Amboree said. "Screening and prevention in those settings not only saves lives but also saves money, preserves quality of life and supports people's ability to contribute to their families and communities."
Published in JAMA Network Open , the findings show that strengthening screening programs at these community-based centers could save thousands of lives and help to eliminate long-standing disparities in cancer prevention.
The health-saving role of FQHCs
The focus on cervical cancer comes amid worrisome trends. While rates in the U.S. have declined dramatically thanks to the HPV vaccine and regular screening, those benefits are not universal. Amboree's earlier research showed that rates of cervical cancer – and particularly late-stage diagnoses – are rising in low-income and rural areas. One reason is that these women often miss out on lifesaving tests that could catch the cancer earlier.
"For decades, we've seen cervical cancer incidence and mortality steadily decline," Amboree said. "But when we look at low-income counties and rural areas, we see the trends reversing. That's alarming for a largely preventable cancer."
FQHCs could offer a solution, as they provide primary and preventive care at reduced cost to more than 30 million Americans. Funded primarily through Medicaid and federal grants, the centers provide high-quality, comprehensive care to patients who might otherwise be unable to access such services. Many of those patients are publicly insured, meaning they are covered by government-funded health insurance programs, such as Medicaid, Medicare or similar noncommercial plans.
"Because they serve so many people who often face barriers to care, FQHCs are uniquely positioned to improve cancer prevention," Amboree explained.
An opportunity to protect more women
Using data from more than 1,300 FQHCs serving over 7.5 million adults eligible for cervical cancer screening and looking at those numbers in tandem with U.S. census data, the researchers examined how expanding cervical cancer screening in FQHCs could affect national health outcomes.
The study confirmed that FQHCs see many screening-eligible women who are historically underserved in health care, including more than a third of all publicly insured women, more than a quarter of women living in rural areas and one in five uninsured women. However, only about 55% of women seen at FQHCs were up to date on cervical cancer screening – far below the national average of 74% and the Healthy People 2030 goal of 79%.
According to the researchers, boosting screening rates in the centers could have a profound impact. Their analyses showed that if FQHCs achieved the Healthy People goal, they would reach an additional 1.87 million women – boosting national screening rates by more than 2 percentage points. That seemingly modest gain could translate into thousands of cancers detected early or prevented altogether.
Because FQHCs serve many of the nation's hardest-to-reach groups, the impact would be felt most strongly among women who often face barriers to screening. The study estimated that if the centers reached national targets, screening rates would rise by up to 6 percentage points among women living in poverty and rural areas and among uninsured and publicly insured women.
"These are women at risk of falling through the cracks," Amboree said. "Investing in these clinics and making screening more accessible there can protect those who need it most."
Cervical cancer, she added, is one of the few cancers with prevention at every stage. HPV vaccination can prevent infections that could lead to cancer, and timely screening can detect and lead to the removal of precancerous lesions. The cancer is also highly treatable: If caught early, five-year survival is around 91%, but once it becomes advanced, that rate falls below 20%.
"There aren't many cancers where you can intervene so effectively," she said. "And we know survival drops dramatically once cervical cancer spreads. That's what makes this screening so urgent – we already have the tools to eliminate the cancer."
Sustaining progress through policy, funding and innovation
Despite those proven tools, many women still go unscreened and undertreated. Amboree pointed to both individual- and system-level barriers that limit access to care. Sometimes health system challenges make it hard for people to get screened, for instance, because of access barriers like transportation, cost or provider shortages.
"Or it can be because of competing priorities – if you have to work or care for children or can't take a day off, preventive care likely isn't going to come first," she noted. "Others may feel anxious about the pelvic exam or simply don't realize how important screening is."
But with proper funding and support, Amboree believes FQHCs can deliver the education, navigation and trust needed to boost screening in the communities that need it most.
The researchers point to new approaches that could help. For instance, the Food and Drug Administration has approved self-collected HPV tests for use in clinical settings, which allow women to collect their own samples without a pelvic exam. Previous research led by UT's Montealegre found that this tool can double screening rates among underscreened women. Pairing self-collection with services that FQHCs already offer, including patient navigation, education and community outreach, could make screening even more accessible.
"When cervical cancer screening is made available to women for whom a standard Pap smear has long been inaccessible or simply unacceptable, the effect is profound," Montealegre said. "Self-collection empowers these individuals with a new, effective option for screening."
The study also emphasizes the need for sustained investment in FQHCs and Medicaid, which millions rely on for preventive care. Amboree pointed to a recent study that cautioned that reductions in funding could reverse progress, potentially adding hundreds of thousands more underscreened women.
The bottom line, according to the study, is that improving cervical cancer screening in FQHCs is one of the most direct ways to reduce cancer screening disparities and move the U.S. closer to eliminating a highly preventable cancer.
"There's not a lot in life we can control," Amboree said. "But this is one thing we can. If you have a cervix and you're able to get screened, talk to a health care professional, ask questions and, if you can, make it a priority. It's one of the best ways to protect yourself."
