You might not be particularly excited when your doctor mentions that you’re due for a mammogram or Pap smear — but these tests have more than proved their worth.
Mammograms and Pap smears — along with other procedures such as colonoscopies — are known as cancer screening tests. They can find cancer or risk factors for cancer, which can allow for earlier diagnosis and treatment than if you waited until obvious symptoms showed up. For example, by the time women come in because they are experiencing some of the symptoms of cervical cancer such as bleeding or pain, the cancer may be further advanced and more difficult to treat.
Unfortunately, too many people don’t get their recommended cancer screenings, and some populations have lower screening rates than others.
For some of these people, barriers to cancer screening can include:
- Language barriers. When comparing those who speak English and those with limited English proficiency — meaning that they don’t speak English very well and may require an interpreter — those who are not proficient have significantly lower screening rates. This suggests that language, understanding and health literacy are factors in the screening disparities.
- Lack of insurance. People who don’t have insurance tend not to be screened as often. For example, colorectal cancer screening among uninsured people aged 50 and over was 30% in 2018. Compare that to the approximately two-thirds of people with private insurance who got colorectal cancer screening when it was due.
- An inflexible work schedule. If someone is working multiple jobs, has a professionally demanding work schedule or has a family to take care of, scheduling an additional appointment can be difficult. They may be working at a job where it’s hard to take time off, or when taking time off really counts against you.
- Cultural attitudes and beliefs. Some people may have immigrated to the U.S. from places where culturally, you only go to the doctor when you’re sick. When a doctor suggests a preventive test, they may say “Why do you want to do that? I feel fine.” Some may actually get scared. I’ve had patients say: “I’d rather not know. I feel fine right now. If I get that mammogram, I’m sure they’ll find something and then I’ll have to get more tests, I’ll have to get more things done.” They may worry that they can’t afford any additional tests or procedures.
- Prior negative medical experiences. If you or one of your loved ones has had bad experiences with the medical system — whether that was a traumatic health event, racism or even just a doctor not listening to you — you may be hesitant to return.
Race, ethnicity and sexual orientation have also been associated with varying cancer screening rates. These factors, compounded by low socioeconomic status, present a major barrier across the racial and ethnic spectrum. Some populations experience multiple barriers at the same time, increasing their risk of not getting screened.
You may have experienced some of these barriers yourself. And unfortunately, differences in cancer screening have consequences. Screening disparities can contribute to differences in cancer diagnosis, treatment and survival rates. More Black women tend to be diagnosed with breast cancer later or when it’s already advanced, compared to, say, white women. That means that it’s harder to treat them and it’s more difficult to cure the disease at that time.
Searching for solutions
There are many ways to potentially tackle cancer screening disparities. We in the health care system have to start thinking out of the box, such as by offering Saturday morning screening clinics for those who have an inflexible work schedule. It’s important to offer culturally and linguistically adapted health education to the population you’re working with. And it always helps when people hear from somebody like them. So some studies have shown that, for example, using advocates from their own community to educate them can help.
And we need to partner with those communities. Oftentimes we as medical professionals think that we have the answers to questions, but sometimes we need to go to the community and community leaders and say, “This is a problem, we want to help, but we don’t know how to help. Can you open our eyes and tell us what it is that we need to do?”
But there are things that you can do as well:
- Make sure you’re up to date on your screenings. The simplest step you can take is to get your own screenings done. Don’t put it off.
- Think about how you talk about your screenings. I’ve come to realize that some people really trust their friends more than they trust their doctors. Someone will say, “I got my mammogram and they really squeeze your breasts, it’s painful!” And I’ve had patients tell me, “I don’t want a mammogram because I’ve heard it’s painful.” Yes, mammograms and Pap smears may cause some discomfort, but it’s very brief, and the benefits outweigh this mild, brief discomfort.
- Encourage your friends and family to get screened. Talk about it with your social network. Tell people, “I got my mammogram done, when are you getting yours done?” We share a lot of things on social media, why not use it to encourage people who may be hesitant about screening?
- Give feedback when you have your screening done. Actually fill out the health care surveys you receive after your visit. This is where you can make suggestions to make screening easier for yourself and others: Maybe they should extend their hours or offer instructions in additional languages.
Cancer screening is powerful. I can think of multiple patients — women in their 30s to their 70s — who got a cancer screening test simply because it was due. Those tests ended up finding something irregular, and we were able to take care of it.
When I see these women later, there’s a change; they’ve become so serious about screening tests. They are so grateful that they were able to get diagnosed and treated.
Screening is a gift for all of us, but it’s one we have to use for it to be our personal gift.
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