Barriers to SOC Screening

Despite the availability of various cancer screenings, many people still face barriers to accessing and undergoing these tests.1,2 Understanding and addressing these barriers is crucial to improving cancer screening rates. Addressing barriers also helps with reducing the disease burden on individuals and achieving health equity in cancer screening, treatment, and care.1-3 This page investigates barriers to cancer screening and explores specific issues that impact colorectal cancer screening.

Lack of awareness or understanding of cancer screening and its importance is a common barrier to getting individuals screened among the general public1,2

Individuals from low-income or underserved populations may face financial, logistical, or cultural barriers to cancer screening, such as lack of insurance coverage or access to transportation4-8

Fear or anxiety related to the screening process, invasiveness, and the potential for receiving a positive result can be significant barriers to cancer screening for some individuals5-8

Barriers to Cancer Screening

The infographic presented below provides a summary of major patient-level barriers that discourage patients from seeking timely cancer screening1,5-8

Pain or discomfort in procedure.
Poor knowledge of risks or value of screening.
Low literacy of language barriers.
Costs due to lack of income or insurance.
Fear of, or worry about, results.
Lack of provider recommendation.
Low priority and delay of scheduling.
Transportation and logistics.

Barrier Deep Dive: CRC screening

Focusing on the barriers present in screening for one cancer type may help shed light on the barriers to screening for cancers in general. This section will explore the limitations and barriers within CRC screening. Low CRC screening rates can be attributed to multiple reported barriers at the patient, provider, and healthcare system levels.6-8 Often these barriers are perceived differently among patients and providers.8,9

  • The number one barrier to CRC screening reported by unscreened patients was lack of a provider recommendation/referral8
  • In a separate study, providers perceived that the primary barriers were at the patient level9
  • Follow-up with colonoscopy after positive stool-based CRC screening results is required for screening benefits to be achieved10

Difference in Patient-Reported Barriers by CRC Screening Status (N=198)8,a

  • The number one barrier reported by unscreened patients was no recommendation/referral by a healthcare provider, followed by fear and finances8
  • Among screened patients, fear and logistics were cited as the major barriers8
Bar chart ranking patient-reported barriers for colorectal screening for patients who have been screened with fear, logistics, and unnecessary being the top 3 reasons.
Bar chart ranking patient-reported barriers for colorectal screening for patients who have not been screened with no recommendation/referral, fear, and finances being the top 3 reasons.

Clinician-Perceived Barriers to CRC Screening (N=93)9,d

  • Clinicians perceived that the number one provider barrier was lack of time to discuss screening (learn more about screening guidelines and screening modalities)9
  • Clinicians perceived that the main system barriers were lack of a reminder system and lack of support staff9
  • Clinicians were asked about their perceived patient barriers —they reported fear, finances, other health issues, lack of awareness, health literacy, and a fatalistic attitude toward cancer as the most common barriers9
Bar chart ranking clinician-perceived barriers to colorectal cancer screening (N=93). Fear of discomfort or pain, and finances were the top patient barriers, lack of time to discuss screening was the top provider barrier, and lack of reminder system and lack of support staff were the top system barriers.

Footnotes

  1. Cluster-randomized trial performed in 11 urban and rural safety-net primary care sites across two health systems aimed at evaluation of self-identified barriers to colorectal cancer screening (N=483). Data were collected through surveys administered in person, by phone, or mail. Previously screened and unscreened participants (age ≥50) were asked about health insurance and access to care, and “What barriers/things got in the way of being screened?”
  2. Fear related to CRC screening manifested in different ways, with patients expressing concerns related to the procedure, sedation, and outcomes of the procedure.
  3. Other barriers include medical mistrust (n=4), lack of information on CRC screening (n=5), religious reasons (n=2), or they simply “don’t want to” (n=7).
  4. Survey-based study of 93 primary care providers from 13 Accountable Care Organization clinics, primarily in rural communities.

List of definitions

CRC: colorectal cancer; SOC: standard of care.


References

  1. American Association for Cancer Research. AACR Cancer Disparities Progress Report 2022. American Association for Cancer Research: Philadelphia. Accessed April 18, 2023. https://cancerprogressreport.aacr.org/wp-content/uploads/sites/2/2022/06/AACR_CDPR_2022.pdf
  2. Brill JV. Screening for cancer: the economic, medical, and psychosocial issues. Am J Manag Care. 2020;26(14 Suppl):S300-S306.
  3. Patel MI, Lopez AM, Blackstock W, et al. Cancer disparities and health equity: A policy statement from the American Society of Clinical Oncology. J Clin Oncol. 2020;38(29):3439-3448. doi:10.1200/JCO.20.00642
  4. Fuzzell LN, Perkins RB, Christy SM, et al. Cervical cancer screening in the United States: challenges and potential solutions for underscreened groups. Prev Med. 2021;144:106400.
  5. Wang GX, Baggett TP, Pandharipande PV, et al. Barriers to lung cancer screening engagement from the patient and provider perspective. Radiology. 2019;290(2):278-87.
  6. Gesink D, et al. Cancer Epidemiol. 2016;45:126-134.
  7. Alexandraki I, Mooradian AD. Barriers related to mammography use for breast cancer screening among minority women. J Natl Med Assoc. 2010;102(3):206-18.
  8. Muthukrishnan M, Arnold LD, James AS. Patients' self-reported barriers to colon cancer screening in federally qualified health center settings. Prev Med Rep. 2019;15:100896.
  9. Wang H, et al. Provider perceived colorectal cancer screening barriers: results from a survey in accountable care organizations. JOJ Public Health. 2017;1(2):555557.
  10. US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977.