New roles for public health in cancer screening

Screening tests for the early detection of breast, cervical, and colorectal cancer are prioritized clinical preventive services that can reduce the burden of cancer in the United States. 1 While significant progress has been made in this area, screening rates for breast and cervical cancers have not improved in almost a decade and rates for colorectal cancer are unacceptably low. Lack of insurance has traditionally been the main factor preventing adults from obtaining cancer screening. 2 Components of the Patient Protection and Affordable Care Act will help address this through Medicaid expansion, subsidized state insurance exchanges, and the elimination of cost sharing. However, access to health insurance and medical care are not the only factors that limit participation in cancer screening. Many people who currently have health insurance and regular access to medical care are not being screened. Based on 2010 National Health Interview Survey data, among adults aged 50 to 75 years with a regular source of medical care, only 62% were up to date with screening for colorectal cancer and only 75% of women in this age range had received a mammogram within the preceding 2 years. 3 Analyses of national Medicare data revealed that, despite coverage of cancer screening services, only 66% of eligible women had undergone a mammogram within the past 2 years 4 and only 47% of adults had insurance claims documenting adequate screening for colorectal cancer. 5 To realize the full potential of anticipated improvements in access to care, public health must provide leadership to ensure that cancer screening is proactive, organized, and equitable.