When it comes to cancer, you want time on your side. The earlier cancer is detected, the easier it is to treat and the better the odds of survival.
Screenings not only find early cancers, they can also spot suspicious cells that haven’t yet turned into cancer, but might over time. “Identifying premalignant findings — such as polyps that can be detected via colonoscopy, or breast tissue changes detected via mammogram — allows for early intervention to decrease the risk of cancer,” says Edith Perez, MD, professor of medicine at the Mayo Clinic.
Screenings save lives, but many Americans are letting the chance for early detection slip by, according to new findings in a 2021 survey. The majority (85%) of respondents to a survey conducted in September on behalf of the Cancer Screen Week initiative agreed that cancer screening is vital, yet they are largely unaware of who would benefit from screening and when to get screened for different cancers. Many are also held back by fear, or by not knowing how to start or pay for the screening process.
1. They Don’t Know Who Should Get Screened
Doctors routinely screen patients for certain types of cancer to increase the chances of catching the disease at an early stage. The goal is to catch cancer before it causes symptoms and when it is easiest and most effective to treat. These screenings may include visual exams to look for signs of skin cancer, Pap tests performed by a gynecologist to look for cervical cancer, and colonoscopies, which may find noncancerous growths in the colon before they become cancerous.
All of these tests are considered valuable tools for people who are at normal risk for cancer and have not experienced symptoms. But among the more than 2,000 adults ages 21 to 60 who responded to the Cancer Screen Week online survey (a collaboration between the American Cancer Society, Genentech, Stand Up To Cancer, and Optum), around two-thirds mistakenly believed that screenings are mostly for people who are at high risk for cancer, have symptoms, or have a history of cancer.
About the same proportion also felt they were not at high risk for cancer and wouldn’t be until they are over the age of 60. In fact, although the median age for a cancer diagnosis is 66, certain cancers are more likely than others to occur in younger people, and therefore should be screened for earlier.
For instance, it is typically recommended that average risk people begin regular screenings for prostate cancer in their 50s, and for breast and colorectal cancer in their 40s. Recommendations advise women to start cervical cancer screening in their 20s. Skin cancer may be a risk for people even younger. Yet two-thirds of survey respondents between the ages of 40 and 60 answered incorrectly — across almost all cancer types — when asked at what ages screenings are recommended. Only 7% of survey respondents were aware that skin cancer screenings could start in your 20s.
Sometimes, cancer can strike even earlier than doctors expect. That’s why Ivis Febus-Sampayo, Chief Officer of Diversity for SHARE, a national nonprofit for women affected by cancer, says it’s important to be vigilant and to be your own health advocate.
Febus-Sampayo was just 36 when she was diagnosed with breast cancer. She’d been complaining of breast pain for months, but it wasn’t until she asked her doctor to do a breast exam that he found a lump and ordered a mammogram. “The more you know the better opportunities you have of working with your medical team, taking the best care of yourself, and using the resources that are available,” she says.
2. They’re Afraid of the Findings, and of COVID
Febus-Sampayo says that one of the top things holding people back from getting routine cancer screenings is the fear of what those tests will reveal. That was reflected in the survey results, which showed that 66% of adults find cancer screenings scary, and 82% are worried about what the screenings will find. Women are more likely than men to be fearful and anxious about them. Many are also worried that the procedures themselves may be painful, invasive or embarrassing. This was particularly common among Black adults.
“Part of it is the history,” Febus-Sampayo says. “If they come from a different country, where people don’t have the medical options we have here, they’re terrified because in their experience when someone has cancer, they die.”
The pandemic may be compounding that fear. After more than a year of largely avoiding in-person appointments and relying on telehealth, some are still hesitant to visit the doctor’s office for anything other than urgent matters. Four in 10 people said that it still feels risky to see a doctor or get a cancer screening because of COVID-19.
3. They Face Access and Affordability Barriers
Access is another critical barrier, especially among Hispanic/Latino respondents and those who do not have health insurance. Among Latino adults, 75% expressed concerns about the cost of cancer screenings. And while most people know that health insurance plans cover preventive screenings, 63% of uninsured respondents were unaware that there are free or low-cost screening options available to them.
“There are resources in the community that provide free local access to cancer screenings,” says Carmen E. Guerra, MD, of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania. For example, free breast and cervical cancer screening and diagnostic testing is available to eligible, un- and underinsured women in all 50 states through the CDC’s Breast and Cervical Cancer Early Detection Program.
Primary care physicians play a pivotal role, not only in helping guide patients on which screenings are appropriate and when, but also helping connect patients to programs that make access and affordability less of an issue. Guerra considers connecting people with primary care “the most important thing that community members can do.” Encouragingly, while one in four people said they had put off seeing their primary care doctor because of COVID, it was the No. 1 thing at the top of respondents’ post-pandemic to-do list.
Most often, cancer screenings are clear. They bring relief and peace of mind to patients. But for those whose screenings reveal something troubling, knowledge is power. And understanding what holds Americans back from these potentially life-saving screenings is the first, crucial step to connecting them to the knowledge and care they need.
