Changes in Cancer Screening Rates Following a New Cancer Diagnosis in a Primary Care Patient Panel

Abstract

Importance: Although screenings for breast and colorectal cancer are widely recommended, patient screening rates vary greatly and remain below public health targets, and primary care physicians' (PCPs') counseling and referrals play critical roles in patients' use of cancer screenings. Recent adverse events may influence PCPs' decision-making, but it remains unknown whether cancer screening rates of PCPs' patients change after PCPs are exposed to new cancer diagnoses. Objective: To investigate whether PCPs' exposures to patients with new diagnoses of breast or colorectal cancer were associated with changes in screening rates for other patients subsequently visiting the affected PCPs. Design, Setting, and Participants: This cohort study used stacked difference-in-differences analyses of all-payer claims data for New Hampshire and Maine in 2009 to 2015. Participants were PCPs caring for patients. Data analysis was performed from June 2020 to May 2022. Exposures: New diagnosis of a PCP's patient with breast cancer or colorectal cancer. Main Outcomes and Measures: Patients' breast and colorectal cancer screening rates within 1 year of a PCP visit. Results: The sample included 3158 PCPs (1819 male PCPs [57.6%]) caring for 1920189 patients (1073408 female patients [55.9%]; mean [SD] age, 41.0 [21.9] years) aged 18 to 64 years. During the study period, 898 PCPs had a patient with a new diagnosis of breast cancer and 370 PCPs had a patient with a new diagnosis of colorectal cancer. In the preexposure period, 68837 female patients (37.3% of those visiting a PCP) underwent breast cancer screening within 1 year of the visit, and 13137 patients (10.1% of those visiting a PCP) underwent colorectal cancer screening within 1 year of the visit. For both cancer types, after exposure to a new cancer diagnosis, PCPs' cancer screening rates displayed a rapid, sustained increase. Breast cancer screening rates increased by 4.5 percentage points (95% CI, 3.0-6.1 percentage points; P