Nearly 18 million US women aged 45 to 64 years were due for at least 1 recommended breast, cervical, or colorectal cancer screening, and more than 4 in 10 were due for multiple screenings, according to findings published in JAMA Network Open.
Researchers analyzed 2024 Behavioral Risk Factor Surveillance Survey data from 68,111 women aged 45 to 64 years, representing a weighted population of 36.2 million US women. The survey-based analysis evaluated up-to-date screening across breast, cervical, and colorectal cancer screening and examined associations with sociodemographic factors and health care access, including insurance coverage, educational attainment, household income, wellness visits, and having a regular health care practitioner.
Overall, 50% of women were up to date with all 3 recommended screenings, 29% were up to date with 2 screenings, 13% were up to date with 1 screening, and 8% were not up to date with any of the 3 screenings. Screening participation increased with age: 35% of women aged 45 to 49 years were up to date with all 3 screenings compared with 59% of women aged 60 to 64 years.
Researchers estimated that 17.9 million women were due for at least 1 screening test. This included 10.3 million women due for a single screening and 7.6 million due for multiple screenings. Colorectal cancer screening represented the largest unmet screening need, with 12.6 million women due for screening.
Screening gaps frequently overlapped. Among women due for colorectal cancer screening, 52% were also due for breast and/or cervical cancer screening. Among women due for breast cancer screening, 73% were also due for cervical and/or colorectal cancer screening. Among women due for cervical cancer screening, 71% were also due for breast and/or colorectal cancer screening.
In multivariable analyses, access-related factors had the largest associations with screening participation. Among women who were up to date with at least 1 screening, a past-year wellness visit was the factor most strongly associated with being up to date with all 3 screenings vs being partially screened. Having a regular health care practitioner and having private insurance vs no insurance were also associated with a greater likelihood of full screening completion. Older age, higher educational attainment, and higher household income were also associated with completion of all recommended screenings.
The researchers identified 2 groups with distinct intervention needs. An estimated 3.2 million women were overdue for all 3 screenings and were more likely to lack insurance coverage and regular health care access, suggesting a need for outreach beyond traditional health care settings, including community health workers, patient navigators, federally qualified health centers, and other safety net resources. By contrast, 15.2 million women were partially screened, and more than 80% of this group reported a wellness visit in the prior year, pointing to missed opportunities within primary care to address multiple screening needs during a single visit.
Women aged 45 to 49 years may be an important outreach target, including 2.4 million who were overdue for colorectal cancer screening alone. National guidelines now recommend colorectal cancer screening beginning at age 45 years. The researchers noted that lower colorectal screening uptake may reflect multiple factors, including perceived cost, time, discomfort, newer screening programs relative to breast or cervical cancer screening, and lower awareness of colorectal cancer risk.
The study had several limitations. Screening histories were self-reported and may have overestimated or underestimated screening use. The survey included the noninstitutionalized US population and did not include Tennessee because of data collection issues, leaving a geographic gap in the national estimate. The researchers excluded respondents with missing cancer screening variables, and those excluded respondents were more likely to be uninsured, which could mean screening gaps were underestimated. The overall 2024 survey response rate was 44%, raising the possibility of nonresponse bias.
The researchers also noted issues specific to cervical cancer screening. The Behavioral Risk Factor Surveillance Survey changed its cervical cancer screening question in 2022, which may complicate comparisons with prior survey years. In addition, the survey asked about hysterectomy but did not distinguish between total and supracervical hysterectomy or assess reasons for hysterectomy. The researchers considered women with a prior hysterectomy to be up to date with cervical cancer screening, an assumption that could affect estimates of cervical screening need.
The researchers acknowledged that bundling screening interventions could create challenges for efficient delivery and follow-up by introducing more complex pathways based on each patient’s screening status. They called for research to determine the key elements of recruitment and intervention design needed to ensure such programs are effective, efficient, and equitable.
Disclosures can be found in the study.
Source: JAMA Network Open
