Disparities in Meeting USPSTF Breast, Cervical, and Colorectal Cancer Screening Guidelines Among Women in the United States

Gabriel A. Benavidez, MPH; Anja Zgodic, MS; Whitney E. Zahnd, PhD; Jan M. Eberth, PhD


Prev Chronic Dis. 2021;18(4):e37 

In This Article

Abstract and Introduction


Introduction: Many sociodemographic factors affect women's ability to meet cancer screening guidelines. Our objective was to examine which sociodemographic characteristics were associated with women meeting US Preventive Services Task Force (USPSTF) guidelines for breast, cervical, and colorectal cancer screening.

Methods: We used 2018 Behavioral Risk Factor Surveillance System data to examine the association between sociodemographic variables, such as race/ethnicity, rurality, education, and insurance status, and self-reported cancer screening for breast, cervical, and colorectal cancer. We used multivariable log-binomial regression models to estimate adjusted prevalence ratios and 95% CIs.

Results: Overall, the proportion of women meeting USPSTF guidelines for breast, cervical, and colorectal cancer screening was more than 70%. The prevalence of meeting screening guidelines was 6% to 10% greater among non-Hispanic Black women than among non-Hispanic White women across all 3 types of cancer screening. Women who lacked health insurance had a 26% to 39% lower screening prevalence across screening types than women with health insurance. Compared with women with $50,000 or more in annual household income, women with less than $50,000 in annual household income had a 3% to 8% lower screening prevalence across all 3 screening types. For colorectal cancer, the prevalence of screening was 7% less among women who lived in rural counties than among women in metropolitan counties.

Conclusion: Many women still do not meet current USPSTF guidelines for breast, cervical, and colorectal cancer screening. Screening disparities are persistent among socioeconomically disadvantaged groups, especially women with low incomes and without health insurance. To increase the prevalence of cancer screening and reduce disparities, interventions must focus on reducing economic barriers and improving access to care.


Approximately 40% of new cancer diagnoses and 25% of cancer deaths among women each year are attributed to 3 types of cancer, all of which are amenable to early detection through screening: breast, colorectal, and cervical cancer.[1] These cancers have 5-year survival rates at or greater than 90% if diagnosed at a localized stage.[1] Because of high survival rates for breast, cervical, and colorectal cancers when detected early, programs such as the National Breast and Cervical Cancer Early Detection Program[2] and the Colorectal Cancer Control Program,[3] which provide screening to low-income, uninsured, and underinsured populations, were developed to increase uptake of screening and subsequent follow-up. Although colorectal cancer screening rates increased from 2000 to 2015 as a result in part of increased use of noninvasive screening methods, the proportion of eligible women being screened for cervical and breast cancer decreased nationally by 4.3% and 3.0%, respectively.[4]

Racial/ethnic minority populations, women of low socioeconomic status, and women residing in rural areas have had worse cancer survival outcomes than their counterparts.[5] From 2013 to 2017, non-Hispanic Black women died of cervical cancer (3.4 per 100,000), breast cancer (27.6 per 100,000), and colorectal cancer (18.5 per 100,000) at higher rates than any other racial/ethnic group.[6] Higher mortality among socioeconomically disadvantaged groups is partly due to receiving a diagnosis at a later stage of disease.[5] Rural disparities in screening uptake are often attributed to lack of access to screening services and longer travel distances for care.[7] The national declines in breast and cervical cancer screening[4] are likely exacerbated among groups that are already socioeconomically disadvantaged and medically underserved, and this exacerbation further widens mortality gaps.[8]

Identifying characteristics associated with not meeting cancer screening guidelines could enhance surveillance of possible disparities among groups of people who have historically been economically or socially marginalized. Understanding these factors, whether modifiable or nonmodifiable, will help guide public health efforts, resource allocation, and policies. The objective of our study was to describe the sociodemographic characteristics associated with women meeting US Preventive Services Task Force (USPSTF) guidelines for breast, cervical, and colorectal cancer screening.