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Cancer Screening Data: Adults Who Have Received Recommended Cancer Screenings by Coverage Type, Education Level, and Race/Ethnicity in 2022
May 03, 2024:Cancer screening for adults plays a pivotal role in early detection, increasing the chances of successful treatment and preventing thousands of cancer deaths. Despite their life-saving potential, many adults may choose to delay or skip these screenings due to various barriers, such as limited access, transportation issues, fear of diagnosis, or poor understanding of the importance. To effectively address the root causes of underutilization, it's crucial to first understand the landscape of cancer screening rates for varied populations and communities.
State Health Compare offers a comprehensive view of state-level data on adults receiving recommended cancer screenings, for the civilian noninstitutionalized population. This valuable resource provides insights into screening rates across different coverage types, education levels, and racial/ethnic groups. Screenings in this data include:
- Pap smears (cervical cancer screening)
- Colorectal cancer screenings
- Mammograms (breast cancer screening)
In this blog post, SHADAC researchers delve into the breakdowns between the different groups to understand disparities and/or differences of cancer screening rates for various populations. For this analysis, we used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) on State Health Compare.
Methods
To begin, we first needed to understand the total number of adults who received recommended cancer screenings. We found that, in 2022, 62.6% of US adults received recommended cancer screenings.
We then conducted statistical testing of rates within each of the previously mentioned demographic categories to see if they were significantly higher or lower than the national rate.
Breakdown by Coverage Type
This breakdown examined cancer screening rates for adults by multiple types of insurance coverage.
Some coverage groups had significantly lower cancer screening rates compared to the national rate. Uninsured adults had the lowest rate of cancer screenings in 2022, with 34.0% receiving recommended cancer screenings. Adults that were insured through Medicaid in 2022 also had a significantly lower rate of receiving annual cancer screenings, with a percentage of 57.7%.
Explanations of why these differences occur vary. One possible explanation is the cost of screenings. Those who are uninsured would be required to pay for cancer screenings out of pocket, which can be expensive and cost prohibitive, leading to people forgoing these services. Additionally, many people and families covered under Medicaid are low-income. Even with insurance coverage, individuals may not be able to pay for preventative screenings, have transportation to appointments, be able to take off work or find childcare, etc.
On the other hand, some coverage groups had significantly higher rates of cancer screenings compared to the national rate. Adults with public insurance and Medicare both had significantly higher rates of receiving cancer screenings, with rates of 66.4% and 70.7%, respectively.
Again, possible explanations for this vary. One explanation is that under the Affordable Care Act, Medicare must cover cancer screenings. This guaranteed coverage could explain the higher rate of individuals with Medicare receiving their recommended screenings.
Of those with individual insurance, 59.0% reported receiving recommended screening, which was not statistically different from the US rate. Adults with private and employer/military insurance also did not have a significant rate of annual cancer screenings compared to the US rate, with 62.5% and 63.2%, respectively, reporting receiving annual cancer screenings.
Breakdown by Education Level
Multiple levels of cancer screening data by educational attainment were examined displayed in the graph below.
Two of these groups had significantly lower rates of adults receiving recommended cancer screenings. First was US adults with less than a high school degree, with 47.2% receiving recommended cancer screenings in 2022 (significantly lower than the US rate). The rate for adults who are high school graduates (without further higher education) is also significantly lower than the US rate at 58.8%.
There is no significant difference between the US rate (62.6%) and the rate for adults with some college or an Associate’s degree (63.0%).
Finally, 68.0% of US adults with a Bachelor’s degree or higher reported receiving recommended screenings, which is significantly higher than the US rate. A possible explanation for this higher rate is that individuals with higher educational attainment may be more knowledgeable regarding the importance of receiving preventative care, as well as having the means to seek preventative care.
As individuals with lower educational attainment have lower rates of cancer screening, they also have higher prevalence of modifiable cancer risk factors. Modifiable risk factors for cancer include smoking, excess body weight, alcohol intake, physical inactivity, and poor diet. There are notable educational disparities in cancer prevention in terms of incidence, treatment, and mortality. This reveals the importance of tailoring screening programs and providing educational material to individuals with lower education levels.
Breakdown by Race/Ethnicity
Finally, we were able to create a breakdown of cancer screening rates by racial/ethnic groups.
Note: these groups were selected based on available data. State Health Compare does not have available data for some race/ethnic groups, due to low response rates. However, SHADAC is hopeful this data gap will be addressed in the future in order to conduct equitable analyses.
Compared to the US rate, Hispanic/Latino adults and adults of other/multiple races had significantly lower rates of receiving recommended cancer screenings in 2022, with respective rates of 55.6% and 56.9%.
Approximately two-thirds of both African American/Black adults (64.6%) and White adults (64.9%) reported receiving recommended cancer screenings—both of which are significantly higher than the US rate.
Our analysis shows that there are differences in cancer screening rates between racial/ethnic groups—with our analysis seeing Hispanic and other/multiple race individuals with the lowest screening rates in the US. Other research supports and, in fact, shows even greater inequities than this. Racial disparities not only impact screening rates, but also cancer diagnosis and treatment. Persons of color may receive later stage cancer diagnoses compared to their White counterparts, due to disparities in screening quality and delays in diagnostic evaluations.
Also, persons of color may not be seeking out cancer screening services due to distrust in the healthcare system, discrimination, bias, or unpleasant past experiences.
Final Thoughts
Examining recommended annual cancer screening rates by coverage type, education level, and racial/ethnic group reveals that although the national rate may seem relatively high, there are still groups that face disparities in accessing and utilizing such a vital tool for improving cancer treatment and preventing death.
While this blog has looked at singular category breakdowns, it is important to note the intersectionality between insurance coverage, education level, race/ethnicity, and many other factors. For example, individuals without a high school diploma have the highest uninsurance rates. Race/ethnicity also appears to be correlated with rates of uninsurance. When looking at race and uninsured rates, there are higher uninsurance rates for American Indian or Alaska Native (AIAN), Hispanic, Black, and Native Hawaiian or Pacific Islander (NHPI) individuals compared to their White counterparts.
Therefore, of the groups that have significantly lower rates of cancer screenings compared to the US rate, many individuals may fall into multiple of these sub-categories. Further research and analysis could shed light on how these many factors interact and lead to different (and varied) results and outcomes.
By understanding these disparities, not only can we draw attention to improving public health education and literacy for these populations, but also find meaningful ways to identify and address barriers (individual and structural) that may be hindering these same individuals from accessing the preventative care they need.
Interested in learning more about disparities and health equity in the United States? You can explore the data yourself using the State Health Compare Tool here.
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