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Insurance Status, Race, and Education Remain Persistent Barriers to Cancer Screening

Surabhi Dangi-Garimella, PhD
While colorectal cancer screening rates have seen a recent progress toward achieving the Healthy People 2020 objectives, breast cancer screening rates have remained static, and cervical cancer screening rates have been declining.
A new report that monitored cancer screening rates between 2000 and 2015, using data from the National Health Interview Survey (NHIS), has found that colorectal cancer screening rates have seen a recent progress toward achieving the Healthy People 2020 (HP2020) objectives, breast cancer screening rates have remained static, and cervical cancer screening rates have been declining. According to the study, published in the Morbidity and Mortality Weekly Report, race, education, income, and insurance status were significant determinants of disparity among participants.

The authors analyzed NHIS data—a nationally representative sample of the civilian, noninstitutionalized population residing in the United States—which gathers information on the household, each person in the family residing in that household, and a randomly selected sample adult (aged ≥18 years) and child (if present) from each family.

With a focus on cancer screening, adults were asked if they had undergone screening, and those who responded in the affirmative were asked to date their latest screening test. For this study, information on the following tests was gathered:

  • Mammography within 2 years for women aged 50 to 74 years
  • Papanicolaou (Pap) test within 3 years for women without a hysterectomy aged 21 to 65 or Pap test with human papillomavirus test within 5 years for women without a hysterectomy aged 30 to 65 years
  • Fecal occult blood test within 1 year, sigmoidoscopy within 5 years and fecal occult blood test within 3 years, or colonoscopy within 10 years for respondents aged 50 to 75 years
The authors evaluated screening trends over time using NHIS data from 2000, 2003, 2005, 2008, 2010, 2013, and 2015. Of the 55.2% of adults who responded, mammography use was found stable from 2000 to 2015. In 2015, 71.5% of women, 50 to 74 years old, had a mammogram, which was below the HP2020 target of 81.1%. Racial disparity was evident, with American Indians/Alaska natives reporting the lowest rate of screening (56.7%). Women who born outside the United States and had been living in the country for <10 years had lower rates (53.7%) than those who were born in the United States (72.1%). Further, not surprisingly, uninsured women and those without a usual source of healthcare reported very low rates (35.3% and 32.9%, respectively).

Cervical cancer screening rates saw an overall decline from 2000 to 2015—it touched 83% in 2015, which was 10% below the HP2020 target. Asian women had the lowest rates of screening (75.8%). Lowest screening rates were reported by younger women, between 21- and 30-years old (78.3%), along with women born outside the United States. Insurance trends persisted—only 65.1% among women who lacked a usual source of healthcare and 63.8% among uninsured women.

Colorectal cancer screening increased from 2000 to 2015 but did not achieve the HP2020 target of 70.5%. Screening rates were lowest among American Indians and Alaska natives (48.4%) and Hispanics (47.4%). Screening rates were lower in the 50 to 64 age group (57.9%), compared with the 65 to 75 age group (71.8%). Education and insurance coverage were significant determinants of increased screening rates.

The authors write, “Innovative approaches are needed to reach some racial and ethnic minorities and medically underserved populations to improve the use of cancer screening test use toward the HP2020 targets.”

 
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