Kale Mills, a fourth-year medical student at KU School of Medicine-Wichita, says the initial idea behind his recently published study on the costs of three cancer screenings at Kansas hospitals was to help fellow Kansans — especially the uninsured — make decisions about where to go for affordable procedures.

The Clearwater, Kansas, native found significant pricing disparities for breast, lung and colon cancer screenings, based on whether a hospital is rural and which area of the state the service is provided.

The findings “highlight the urgent need for equitable access to cancer screenings in Kansas,” the study said.

“Urban hospitals charged higher prices for chest computed tomography (CT) scans, while rural hospitals had elevated costs for colonoscopies and mammograms,” according to the study published in the Feb. 17 issue of the Kansas Journal of Medicine.

The substantial price differences charged by northeast Kansas hospitals for colonoscopies were one notable example. The cost ranged from $595 to $11,684. Median screening prices statewide were $2,247 for colonoscopies, $1,109 for chest CT scans and $228 for mammograms.

Mills co-authored the study with Nicole Freund, Ph.D., assistant professor in the KUSM-Wichita Department of Family & Community Medicine. Mills collected the pricing information by visiting the websites of all 124 Kansas hospitals. Under the Hospital Price Transparency Rule, which took effect in 2021, all hospitals are required to disclose standard charges for services and procedures online.

Regular preventive screenings for breast, lung and colon cancers can help find cancers early, when treatment is likely to work best, according to the Centers for Disease Control and Prevention.

A colonoscopy should be conducted every 10 years starting at age 45 and a mammogram should be done at age 40 and continue annually until age 75, according to the evidence-based recommendations set by the medical experts comprising the independent U.S. Preventive Services Task Force. An annual lung screening is recommended for individuals ages 50 to 80 who have at least a 20-pack-per-year smoking history and currently smoke or have quit in the past 15 years.

But for those patients who are uninsured, paying for these multiple screenings out-of-pocket can be expensive, the co-authors said.

“With our state, a very significant portion of rural individuals are not insured, so if you take that into account, pricing is a significant cost to bear,” Mills said in an interview.

For the past three years, the Kansas uninsured rate has been higher than the national uninsured rate.

The Kansas uninsured rate was 8.4% while the national rate was 7.9% in 2023, according to the most recent data available from the U.S. Census Bureau. 

Another research outcome

While Mills’ study has gotten some media attention, doing research provides another important outcome for medical students.

“There’s no lack of assessments for medical students, but conducting research is one way for them to truly distinguish themselves,” Freund said. She is one of two research faculty members in the Department of Family & Community Medicine who help students, residents and faculty carry out applied research projects. Dulcinea Rakestraw, Ph.D., MPH, is the other research faculty member.

“It’s a really important tool for critical thinking, so the students who take advantage of it, I think, get a richer experience,” Freund said.

Figuring out the aspects of a research project — such as what to research, doing the literature review, determining what and how data is collected, and how to present the results — is part of that experience.

For Mills’ project, “he was the one who came up with the topic, did the literature review and did the legwork to collect all the pricing. I was on the back end, working on analysis and draft editing, acting as more guide than creator,” Freund said.

Mills said faculty support and encouragement for medical students to do research is what motivated him to get involved with two other research projects before undertaking his cancer screening costs study. One of the prior projects was related to vaccine hesitancy, which refers to delaying or refusing vaccinations, while the other focused on no-show appointment rates at primary care clinics.

“In my opinion, one of the best ways to understand research is to complete a research project. Future physicians and clinicians definitely need to be able to efficiently read and glean information from clinical studies that ultimately inform how we practice and how we do things. Understanding what goes into the research process is important,” Mills said.

“I think additionally … it can provide an edge in a residency application. It makes you a well-rounded applicant by showing that you were not only studying and taking tests in medical school but also engaging in the intellectual pursuits of research.”

Mills was recently matched with the Otolaryngology-Head and Neck Surgery Residency Program at the University of Louisville School of Medicine in Kentucky.

Above, left: Kale Mills

Above, right: Nicole Freund, Ph.D.