Study finds racial and ethnic disparities in US cancer screening rates

Screening rates lower among Asian and Hispanic Americans

The percentage of U.S. citizens screened for cancer remains below national targets, with significant disparities among racial and ethnic populations, according to the first federal study to identify cancer screening disparities among Asian and Hispanic groups. The report by the Centers for Disease Control and Prevention and the National Cancer Institute (NCI), part of the National Institutes of Health, was published today in the CDC Morbidity and Mortality Weekly Report.

In 2010, breast cancer screening rates were 72.4 percent, below the Healthy People 2020 target of 81 percent; cervical cancer screening was 83 percent, below the target of 93 percent; and colorectal cancer screening was 58.6 percent, below the target of 70.5 percent, according to the study, “Cancer Screening in the United States – 2010.”

Screening rates for all three cancers were significantly lower among Asians (64.1 percent for breast cancer, 75.4 percent for cervical cancer, and 46.9 percent for colorectal cancer) compared to other groups, the study found.  Hispanics were less likely to be screened for cervical and colorectal cancer (78.7 percent and 46.5 percent, respectively) when compared to non-Hispanics (83.8 percent and 59.9 percent, respectively).

“It is troubling to see that not all Americans are getting the recommended cancer screenings and that disparities continue to persist for certain populations. Screening can find breast, cervical, and colorectal cancers at an early stage when treatment is more effective,” said Sallyann Coleman King, M.D., an epidemic intelligence service officer in CDC’s Division of Cancer Prevention and Control and lead author of the study. “We must continue to monitor cancer screening rates to improve the health of all Americans.”

sets national objectives for improving the health of all Americans. Such objectives include the use of screening tests recommended by the United States Preventive Services Task Force for breast, cervical, and colorectal cancers. Women aged 50-74 years should be screened for breast cancer with a mammogram every two years. Women who have been sexually active for three years or are aged 21-65 years should be screened for cervical cancer with a Pap test at least every three years. Colorectal cancer screening is recommended for average-risk men and women aged 50-75 years, using high-sensitivity fecal occult blood test (FOBT), done at home every year; sigmoidoscopy every five years, with high-sensitivity FOBT every three years; or colonoscopy every 10 years.

To assess the use of currently recommended cancer screening tests by age, race, ethnicity, education, length of residence in the United States, and the source and financing of health care researchers analyzed data from the 2010 National Health Interview Survey, which tracks progress toward the achievement of  Healthy People 2020 objectives.  For the ethnic subgroups, Asians were classified as Chinese, Filipino, or other Asian and Hispanics as Puerto Rican, Mexican, Mexican-American, Central or South American, or other Hispanic.

Significant findings include:

Screening rates for breast cancer remained relatively stable and varied no more than 3 percent over the period 2000-2010.

From 2000-2010, colorectal cancer screening rates increased markedly for men and women, with the rate for women increasing slightly faster so that rates among both sexes were nearly identical (58.5 percent for men and 58.8 percent for women) in 2010.

From 2000-2010, a small but statistically significant downward trend of 3.3 percent was observed in the rate of women who reported getting a Pap test within the last three years.

Considerably lower breast, cervical, and colorectal cancer screening use was reported by those without any usual source of health care or health insurance.

The authors note that this study reinforces the need to identify and track cancer screening disparities. Additionally, the report provides guidance for the development programs to increase the use of screening tests in order to meet Healthy People 2020 targets and simultaneously reduce cancer morbidity and mortality.

“Healthy People objectives are important for monitoring progress toward reducing the burden of cancer in the United States. Our study points to the particular need for finding ways to increase the use of breast, cervical, and colorectal cancer screening tests among Asians, Hispanics, as well as adults who lack health insurance or a usual source of health care” said Carrie Klabunde, Ph.D., an epidemiologist in NCI’s Division of Cancer Control and Population Sciences and a co-author of the study.

According to the authors, the Affordable Care Act is expected to reduce financial barriers to care by expanding insurance coverage. Other efforts are needed such as developing systems that identify individuals eligible for cancer screening tests, actively encouraging the use of screening tests, and monitoring participation to improve screening rates, they say.

Through the National Breast and Cervical Cancer Early Detection Program, CDC provides low-income, uninsured, and underinsured women access to timely breast and cervical cancer screening and diagnostic services in all 50 states, the District of Columbia, five U.S. territories, and 12 American Indian/Alaska Native tribes or tribal organizations. The CDCs Colorectal Cancer Control Program funds 25 states and four tribal organizations to implement population-based approaches to increase screening among men and women aged 50 years and older. Population-based approaches include policy and health systems change, outreach, case management, and selective provision of screening services. For information about CDC efforts to prevent cancer, visit www.cdc.gov/cancer

NCI leads the National Cancer Program and NIH’s effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, visit www.cancer.gov  or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

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