President's Cancer Panel

Closing Gaps in Cancer Screening:

Connecting People, Communities, and Systems to Improve Equity and Access




Screening for breast, cervical, colorectal, and lung cancers has been shown to save lives and reduce the burden of cancer. However, gaps in cancer screening mean too many in the United States are enduring aggressive treatment for or dying from cancers that could have been prevented or detected at earlier stages with screening. This includes disproportionate numbers of socially and economically disadvantaged populations and a large percentage of those with hereditary cancers. This avoidable burden of cancer imposes a heavy physical, emotional, and economic toll on individuals, families, and communities around the country. It also has broader economic implications, reducing workforce productivity and adding unnecessary strain to the healthcare system.

The President’s Cancer Panel has determined that more effective and equitable implementation of cancer screening represents a significant opportunity for the National Cancer Program, with potential to accelerate the decline in cancer deaths and, in some cases, prevent cancer through detection and treatment of precancerous lesions. All stakeholders, large and small, need to take collaborative action to optimize cancer screening through better communication, access, and implementation.

Communication. Improvements in dissemination of guidelines and best practices for cancer risk assessment and screening are needed. More effective communications campaigns and educational strategies are essential to ensure that the public and healthcare providers have sufficient knowledge about cancer risk factors, screening benefits, and key eligibility criteria. The existence of multiple guidelines, changes in guidelines, and the evolution of screening modalities can cause confusion about screening. Coordination among stakeholders—including guideline makers—would facilitate alignment of key messages and development of strategies to promote screening. Communications campaigns must be tailored to reach and resonate with populations that may have different values, priorities, and cultural and communication norms, and, sometimes, different languages. Alignment of larger stakeholders with smaller, community-embedded organizations will facilitate delivery of effective messaging to populations experiencing gaps in cancer screening.

Access. Steps must be taken to ensure that every person in the United States has access to high-quality cancer risk assessment, genetic testing and counseling, cancer screening, and follow-up care. Legislative and policy changes have helped address insurance and cost issues, but this is often not sufficient. Community-oriented outreach and support services are needed to identify and address the social, cultural, economic, and logistical barriers that deter people from seeking out, initiating, and completing cancer screening and receiving recommended follow-up care in the case of an abnormal screening test result. Self-sampling approaches also should be pursued to extend the reach of cancer screening.

Implementation. Better implementation of screening guidelines will allow healthcare providers and systems to identify eligible people, make appropriate recommendations, and guide patients to complete all recommended screening and follow-up in a timely manner. Changes are needed to make it as easy as possible to support cancer screening. Well-rounded healthcare teams are needed to meet patients’ needs effectively and efficiently, and all team members must be empowered to use the full extent of their skills and training. Improved health information technology is needed to help healthcare teams apply the growing and increasingly complex set of cancer risk assessment and screening guidelines so they can deliver the right care to the right people at the right time. The technology needed to create these tools is available; steps must be taken to adapt and apply it more uniformly within our healthcare system.

The Panel urges all stakeholders—healthcare providers, healthcare systems, payors, community and patient advocacy organizations, government agencies, and individuals—to work together to close gaps in cancer screening and ensure that the benefits reach all populations. Improved early detection and prevention of cancer through screening will reduce the burden of the disease on individuals, families, communities, and the nation.