Early detection saves lives only when patients can access care

Several years ago, two men attended a community health fair at a church in Newark. Neither came looking for a cancer diagnosis. They came to a neighborhood event where prostate cancer screening was among the services being offered. Both men had their prostate-specific antigen, or PSA, levels checked. Both results came back abnormally high. What happened next illustrates something we don't talk about enough when discussing cancer screening and healthcare more broadly. The first man was connected with a urologist and completed the diagnostic evaluation that revealed prostate cancer at an early stage. He underwent radiation treatment. At times, we even helped arrange transportation so he could get to the appointments he needed. Today, he is cancer-free. The second man's PSA was also abnormal, and he was advised that he needed further evaluation. But transportation was a problem. He could not reliably get to the appointments necessary to complete his diagnostic workup. Years later, he arrived at an emergency department complaining of back and abdominal pain. This time, he was diagnosed with stage IV prostate cancer. His cancer was no longer curable. Two men. The same community health fair. The same screening test. The same warning that something might be wrong. But two profoundly different outcomes. As an oncologist at Saint Michael's Medical Center in Newark, I think about patients like these when September brings Prostate Cancer Awareness Month and another wave of messages about the importance of cancer screening. Those messages are important. We should continue educating people about cancer prevention and early detection. But awareness was not the problem for either of these men. The gap between awareness and affordability Our national conversation about health care devotes enormous attention to affordability. But between awareness and affordability lies another problem that receives far less attention: accessibility. A cancer screening test can be available. It can even be free. But if a patient cannot get to the test, cannot take time away from work, cannot find a specialist, cannot navigate the health care system or cannot return for the diagnostic evaluation that follows an abnormal result, that care is not truly accessible. Whether someone lives in Newark or a more affluent community, the principle should be the same: Our zip code should not determine the quality of health care we receive, the type of care available to us or our ability to access it. Yet zip codes can reflect differences in transportation, access to primary care and specialists, language resources, employment flexibility and the ability to navigate an increasingly complicated health care system. For cancer patients, those differences can become particularly consequential. Taking health care into the community At Saint Michael's, we have seen the importance of taking cancer prevention beyond the walls of the hospital. Through community outreach and programs such as our In The Pink Cancer Early Detection and Education Program, eligible uninsured and underinsured residents can access education and screening for prostate, breast, cervical and colorectal cancers. Health fairs at churches and other community locations are part of the same philosophy: If people are not reaching health care, health care must become better at reaching people. But bringing a screening test into the community solves only part of the problem. An elevated PSA may require additional testing, imaging, specialist evaluation and sometimes a biopsy. An abnormal mammogram requires follow-up. A positive colorectal cancer screening test may require a colonoscopy. When access becomes the barrier Transportation may sound like a relatively minor logistical challenge compared with the complexity of modern cancer medicine. But for patients who cannot get to an appointment, transportation may be the barrier standing between an abnormal screening test and a cancer diagnosis. The same is true of inflexible work schedules, language barriers, difficulty obtaining appointments, lack of primary care and uncertainty about how to navigate the health care system. Modern oncology has made extraordinary advances. But the most sophisticated cancer treatment in the world cannot help a patient who never reaches it. That is why hospitals and health systems, particularly those serving urban communities, have a responsibility that extends beyond caring for patients who arrive at their doors. Wherever a person lives, whatever their income and whatever their zip code, everyone deserves a meaningful opportunity to benefit from the advances modern medicine has created. This September, we should continue telling men about prostate cancer and the importance of discussing appropriate screening with their physicians. We should continue working to make health care affordable. But we must devote the same urgency to making health care accessible. Because early detection saves lives only when patients can reach what comes next. Dr. Hamid Shaaban is the director of Cancer Center at Saint Michael's Medical Center and clinical assistant professor of hematology and oncology at New York Medical College.