President's Cancer Panel

Closing Gaps in Cancer Screening:

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



The President’s Cancer Panel was established in 1971 by the National Cancer Act (P.L. 92-218) and is charged with monitoring the progress of the National Cancer Program—which includes all public and private activities focused on preventing, detecting, and treating cancers and on cancer survivorship—and identifying barriers to reducing the burden of cancer. The Panel investigates topics of high importance to the National Cancer Program for which actionable recommendations can be made. Information is collected through workshops, discussions with subject matter experts, and review of peer-reviewed and gray literature. Findings and recommendations are compiled in reports to the President of the United States.

For its 2020–2021 series, the Panel focused on uptake of cancer screening. The Panel convened the Working Group on Cancer Screening During the COVID-19 Era to inform the planning of five virtual, public workshops. The first four workshops each focused on a specific cancer type: lung, colorectal, cervical, and breast. The final workshop explored innovations with potential to improve cancer screening. All workshops engaged a range of stakeholders, including patients, patient advocates, healthcare providers, academic researchers, oncologists, health economists, statisticians, and intellectual property specialists, as well as representatives from healthcare systems, federal agencies, media outlets, insurance companies, and the biopharmaceutical industry.

Cancer screening has contributed to substantial reductions in cancer deaths in the United States over the past few decades. Despite its well-known benefits, uptake of cancer screening is incomplete and uneven. Rates for lung cancer screening—which has been recommended by the U.S. Preventive Services Task Force (USPSTF) for less than 10 years—are particularly low. While rates for breast, cervical, and colorectal cancers are higher, they are still well below targets. Furthermore, many people who receive an abnormal screening result do not receive recommended follow-up care in a timely fashion. Gaps in screening and receipt of follow-up care are even more pronounced in some sociodemographic groups, including people who do not have a usual source of healthcare or adequate health insurance, have low education or income, live in rural or remote areas, and/or are members of some racial/ethnic minority groups.

The Panel concluded that closing these gaps through more effective and equitable implementation of cancer screening is 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 removal of precancerous lesions. Many trends in the U.S. healthcare system—including expanding access to high-quality health insurance, the shift toward value-based medicine, increased adoption of telehealth, and a commitment to data sharing and interoperability of health information systems—have potential to support cancer screening, but these efforts are not sufficient. Targeted actions at the national and local levels are needed to empower the American people and healthcare providers to seek and promote cancer screening.

In this report, the Panel presents strategies for closing gaps in cancer screening. These include efforts to increase overall rates of appropriate screening and follow-up care, as well as actions to ensure that the benefits of cancer screening reach all populations and communities. While this report is presented to the President of the United States, the recommendations also are for the diverse stakeholders that make up the National Cancer Program. By implementing the Panel’s recommendations, these stakeholders—large and small, public and private, national and local—will connect people, communities, and systems to ensure the benefits of cancer screening reach all populations.