Lack of Access to Screening Leads to More Advanced Cancer in Socially and Economically Challenged Populations

John P. Williams, MD

Many Americans, particularly those in communities of color or socially and economically challenged populations, are presenting with advanced-stage disease, enduring aggressive treatment, and dying from cancers that should be detected early, according to a report from the President’s Cancer Panel. The report’s authors called for immediate action to implement effective and equitable access to cancer screening.¹

The committee acknowledged that there is no single factor responsible for disparities in access to cancer screening. However, the report pointed to lack of awareness, logistical challenges, fear and stigma, and financial concerns as barriers to entry for underprivileged communities.

“While screening rates were not high enough prior to 2020, during the pandemic, cancer screenings such as mammograms, colonoscopies, HPV and PAP tests, and lung cancer screenings were postponed or canceled, in many cases labeled as ‘elective.’ We must correct the misperception that cancer screening is ‘elective,’” John P. Williams, MD, chair of the President's Cancer Panel, said in a news release. “We need to learn from the time of disruption and seize this time of opportunity because the long-term impact of missed or delayed screenings is that more people will die from cancer.”

Although improved early detection and screening have prevented an estimated 3.2 million cancer deaths the United States since 1991, experts expected more than 1.9 million new cases and 600,000 cancer deaths in 2021.² The US Preventive Services Task Force has recommended screening for breast, cervical, colorectal, and lung cancer in eligible patients, and upticks are needed to reach desired rates.^3-6

The National Cancer Program has the opportunity to reduce future cancer deaths and prevent cancer by more effectively and equitably implementing cancer screening and risk assessments. Along with stressing the need for communication, access, and implementation to deliver cancer screenings to all populations, the report identified 4 primary goals and specific recommendations to increase access to across various communities:

Improve and Align Communication

Though general awareness of the benefits of cancer screening is high and a substantial portion of people undergo regular screening, a substantial part of the populationstill suffers with a poor understanding of those benefits. The panel recommended government development of effective communications about cancer screening, with the goal of reaching all populations. Along with making access to information easy, the committee aims to address common concerns and misconceptions in clear terms, while clearly defining the next steps for patients seeking screening.

The panel also recommended an expansion and strengthening of National Cancer Roundtables to include a focus on cancer screening. Past roundtables have helped coordinate national efforts in specific areas of need. The recommendation said new roundtables should include a strong focus on screening for breast and cervical cancer. Additionally, increased financial support should help lung cancer and colorectal cancer (CRC) screening expand in areas with lower rates of screening and follow-up care.

Facilitate Equitable Access

Geographic, financial, and logistical factors all create barriers to health care services, including cancer screening. Additionally, fear of judgement, apprehension about potential diagnosis, distrust of health care systems, and structural racism all play a role in creating barriers within different communities.

The panel said cost must not be a barrier for patients trying to access cancer screening. Furthermore, physicians should use telehealth to grant additional access to patients during the COVID-19 pandemic. The group called for the establishment of sustainably-funded, community-oriented outreach and support services to ensure all populations receive appropriate screening and follow-up care.

The panel also recommended an increase in self-sampling as a way of screening for cancer. CRC and cervical cancer both have at-home methods of self-screening. The panel pointed to stool-based tests to aid those at risk for CRC who are hesitant or unable to undergo a colonoscopy. Additionally, the authors called on HPV test manufacturers to push for validation efforts and regulatory approval of their tests.

Strengthen Workforce Collaborations

The many demands on providers limit their ability to thoroughly address the needs of every patient when determining if or when cancer screening is necessary. Therefore, the panel pushed for the introduction of supportive policies and a commitment to team-based care approaches.

The panel recommended all members of a health care organization support cancer screening. If team members such as nurses, medical assistants, and office staff can provide help to patients who might be eligible for screening would help to increase awareness and push more people to undergo crucial tests.

Though cancer screening guidelines typically exist for the general population, some individuals are at elevated risk due to genetics. The panel recommended increased access to genetic testing and counseling to better identify and screen higher-risk patients with a family history of cancer or who carry specific genetic mutations.

Create Effective Health IT

Information overload can restrict the ability of patients to access and process the all the information around cancer screening. Health care providers must ensure patients can easily access relevant materials to better understand who a candidate for cancer screening is.

The panel recommended the creation of computable versions of cancer screening and risk assessment guidelines. Converting these guidelines into more structured formats that can be easily accessed on a computer will improve access while also helping to create universal screening guidelines, replacing independent and outdated formats.

Additionally, the panel pushed for the creation and deployment of clinical decision support tools to help providers and patients access and integrate clinical knowledge to cancer risk assessment and screening.

References

1. Closing gaps in cancer screening: connecting people, communities, and systems to improve equity and access. President’s Cancer Panel. Published February 2022. Accessed February 4, 2022. https://bit.ly/35QfF0x
2. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7-33. doi:10.3322/caac.21654
3. US Preventive Services Task Force. Final recommendation statement: lung cancer: screening. Rockville (MD): USPSTF. Published December 31, 2013. Accessed February 4, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
4. US Preventive Services Task Force. Final recommendation statement: breast cancer: screening. Rockville (MD): USPSTF. Published January 11, 2016. Accessed February 4, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening
5. US Preventive Services Task Force. Final recommendation statement: colorectal cancer: screening. Rockville (MD): USPSTF. Published May 18, 2021. Accessed February 4, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
6. US Preventive Services Task Force. Final recommendation statement: cervical cancer: screening. Rockville (MD): USPSTF. Published Aug 21, 2018. Accessed February 4, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening