Clinical Scorecard: Obstacles to Accessing Health Care and Cancer Screening Services
At a Glance
Category
Detail
Condition
Cancer screening for breast, cervical, colorectal, lung, and prostate cancers
Key Mechanisms
Early detection via routine screening reduces morbidity and mortality; barriers limit screening uptake
Target Population
US adults aged 18 years and older, including diverse and historically underrepresented groups
Care Setting
Primary care and preventive health care settings across the US
Key Highlights
Routine cancer screening per USPSTF guidelines significantly reduces cancer mortality and morbidity.
Substantial disparities exist in screening rates across demographic, socioeconomic, and geographic groups.
Multiple barriers including financial constraints, limited health literacy, and logistical challenges impede screening participation.
Guideline-Based Recommendations
Diagnosis
Use USPSTF guidelines for screening eligibility and intervals for breast (grade B), cervical (grade A), colorectal (grade A), lung (grade B), and prostate (grade C) cancers.
Management
Offer routine cancer screening to eligible individuals according to USPSTF grades A and B.
Selectively offer prostate cancer screening based on clinical judgment due to grade C recommendation.
Monitoring & Follow-up
Ascertain screening adherence through electronic health record (EHR) data using procedure and laboratory codes.
Ensure adequate EHR follow-up duration matching screening intervals for accurate adherence assessment.
Risks
Recognize that lack of insurance and financial barriers increase risk of under-screening.
Address psychosocial and logistical barriers such as transportation, childcare, and work constraints to reduce screening delays.
Patient & Prescribing Data
Over 600,000 US participants from the NIH All of Us Research Program, including underrepresented minorities and low-income groups.
Screening adherence varies widely; 20-29% of women missed routine breast, cervical, or colorectal cancer screening; 65-83% of individuals missed prostate or lung cancer screening.
Clinical Best Practices
Incorporate patient-reported barriers and sociodemographic factors when counseling about cancer screening.
Utilize large, diverse cohort data to identify and address multifactorial obstacles to screening.
Promote public health initiatives targeting financial, educational, and logistical barriers to improve screening uptake.
by Aaron A. Gurayah, Anjile An, Manish Kuchakulla, Faith Morley, Daniel M. Markowitz, Jialin Mao, Meenakshi Davuluri, Bashir Al Hussein Al Awamlh, David M. Nanus, Rulla M. Tamimi, Kevin H. Kensler
