Cancer prevention and screening efforts accounted for 4.75 million deaths averted from 1975 to 2020. Though early detection through routine cancer screening remains one of the most effective strategies for reducing morbidity and mortality associated with common malignant tumors, substantial disparities persist in screening across various groups.
A complex interplay of individual, systemic, and societal factors contributes to the underuse of cancer screening services, with barriers such as limited health literacy and financial constraints affecting screening participation. To better understand these factors, Dr. Kevin Kensler, assistant professor of population health sciences, Dr. Aaron Gurayah, third-year urology resident at Weill Cornell Medicine, and colleagues conducted a study examining the obstacles associated with screening for five of the most common cancer types: breast, cervical, colorectal, lung, and prostate. Published in JAMA Network Open, the study combined electronic health record data with data from the National Institutes of Health (NIH) All of Us (AoU) program. The AoU program helps capture data from populations that are historically underrepresented in research.
Study participants self-reported whether nine potential barriers to care delayed their medical care in the past year. Results indicated that out-of-pocket costs, nervousness about seeing clinicians, and inability to get time off work were the most cited barriers across cancer subtypes. Participants with three or more barriers to care had significantly lower screening rates than those who reported no barriers. However, screening adherence was low overall, and financial burdens were associated with reduced odds of screening across all five cancer types.
“Our findings suggest that barriers to cancer screening rarely occur in isolation, as patients often face overlapping financial, logistical, and psychosocial challenges,” said Dr. Gurayah. “Coordinated, multi-level interventions are needed to reduce disparities and improve access across populations.”
Researchers recommend that future studies explore how sociodemographic factors may modify the role of perceived health care barriers in cancer screening, particularly within individual cancer types and across different demographic groups.
“This study highlights the need to address barriers to health care access as a core component of cancer control,” said Dr. Kensler. “Improving screening rates will require not just awareness campaigns, but structural solutions that make it easier for people to access care in the first place.”
- Highlights