People Not Getting Cancer Screenings; Little Progress on Testing Goals

According to a new, May 8, 2015, Centers for Disease Control and Prevention report, many adults in the U.S. are not getting the recommended screening tests for colorectal, breast, and cervical cancers. For 2013, screening for these types of cancers either fell behind previous rates or showed no improvement. Regular breast, cervical, and colorectal cancer (CRC) screening with timely and appropriate follow-up and treatment reduces deaths from these cancers.


Among adults in the age groups recommended for screening, about one in five women reported not being up-to-date with cervical cancer screening, about one in four women reported not being up-to-date with breast cancer screening, and about two in five adults reported not being up-to-date with colorectal cancer screening.


The report found that colorectal cancer testing was essentially unchanged in 2013 compared with 2010. Pap test use in women age 21-65 years was lower than 2000, and the number of mammography screenings was stagnant, showing very little change from previous years.


“It is concerning to see a stall in colorectal cancer screening rates,” said Lisa C. Richardson, M.D., M.P.H., director of the CDC’s Division of Cancer Prevention and Control. “We must find new ways to make people and providers aware that getting tested for colorectal cancer could prevent cancer and save their lives.”


Researchers reviewed data from the National Health Interview Survey 2013, which is used to monitor progress toward Healthy People 2020 goals for cancer screening based on the most recent U.S. Preventive Services Task Force guidelines. The screening data for 2013 show that 58.2 percent of adults age 50-75 years reported being screened for colorectal cancer; 72.6 percent of women age 50-74 had a mammogram; and 80.7 percent of women age 21-65 had a Pap test. All of these percentages are below the Healthy People 2020 targets.


The report found that adults without insurance or a usual source of healthcare generally had the lowest screening test use. For example, less than one-quarter of adults in these groups reported recent colorectal cancer screening, compared with more than 60 percent of adults with private insurance or a usual source of healthcare.


The authors did report some good news: the proportion of women in the highest education and income groups who were screened for breast cancer exceeded the Healthy People 2020 target, and the proportion of people age 65-75 that were screened for colorectal cancer was also near the target.


There are financial and nonfinancial barriers to receiving preventive services. Through the Affordable Care Act, more Americans will qualify to get health care coverage that fits their needs and budget, including important preventive services such as screening for some cancers that may be covered with no additional costs. Efforts are needed to understand why screening percentages are not increasing, and, for Pap tests, are decreasing. It is unknown whether screening intervals might have been lengthened for some women after the 2012 updated recommendation, and if so, whether this might have contributed to decreased screening use as measured in the 2013 findings.


Progress toward meeting Healthy People 2020 cancer screening targets was not observed in 2013 compared with 2010. Mammography use remained essentially stable, Pap test use declined, and CRC test use was essentially unchanged. Some subgroups attained or neared 2020 targets. The proportion of women in the highest education and income groups who were screened for breast cancer exceeded the target; the percentage of privately insured women screened was near the target value. The proportion of persons aged 65–75 years who were screened for CRC also was near the target value.


Those furthest below targets were generally those without insurance or a usual source of care. For these groups, screening use was 42–53 percentage points below breast and CRC screening targets, and approximately 30 percentage points below the cervical cancer screening target. Reported screening for all three cancers was similar between whites and blacks and lower for Hispanics, with variation among racial and ethnic subgroups.


The Colorectal Cancer Control Program provides funding to 25 states and four tribes across the U.S. The program supports population-based screening efforts and provides colorectal cancer screening services to low-income men and women age 50–64 years who are underinsured or uninsured for screening, when no other insurance is available


The Screen for Life: National Colorectal Cancer Action Campaign informs men and women aged 50 years and older about the importance of having regular colorectal cancer screening tests.


The National Breast and Cervical Cancer Early Detection Program provides access to breast and cervical cancer screening services to underserved women in all 50 states, the District of Columbia, five U.S. territories, and 11 tribes.


See the CDC Announcement


See the CDC Report


See also Medical Law Perspectives, October 2012 Report: Mistakes in Diagnosing Cancer: Liability Concerns for Misdiagnosis, Failure to Diagnose, and Delayed Diagnosis


See the Medical Law Perspectives October 24, 2014, Blog: Medical Expert Testimony Not Necessary to Establish Standard of Care for Failure to Communicate Cancer Diagnosis