ASPO Abstracts
Financial hardship is associated with lower uptake of colorectal, breast, and cervical cancer screenings
Category: Financial Hardship Associated with Cancer
Conference Year: 2020
Abstract Body:
Purpose: Rising healthcare costs and financial hardship are considerable barriers to cancer screening. This study
examined associations between financial hardship and cancer screening in Indiana, a state with the 10th highest
cancer mortality rate in the U.S.
Methods: Surveys were mailed to a stratified random sample of 7,979 people ages 18-75 who were seen at least
once in the statewide health system during the previous year and lived in Indiana counties with higher than
average cancer mortality. Participants reported whether they had needed to see a doctor in the past year, but
could not due to cost. This was compared to uptake of mammogram, colonoscopy/sigmoidoscopy, and Pap testing
in a logistic regression analysis controlling for age, race/ethnicity, and marital status among participants who were
eligible for these screening tests based on USPSTF guidelines.
Results: 970 surveys were returned, with 52% female respondents, 73% non-Hispanic White, and 76% over age
50. Approximately 15% (n=142) reported they had not been able to see a doctor due to cost, and this was higher
among Black than White participants (24% vs. 13%; p=0.001). Of those who were screening age eligible, 80%
reported having a mammogram in the last 2 years (n=360), 83% reported ever having had a
colonoscopy/sigmoidoscopy (n=735), and 75% had received a Pap test in the last 3 years (n=186). In the
regression analysis, those who reported not being able to see a doctor in the last 12 months due to cost were
significantly less likely to have had a mammogram (AOR=0.44; 95% CI=0.20-0.95) and to have ever had a
colonoscopy/sigmoidoscopy (AOR=0.45; 95% CI=0.27-0.76). They also were less likely to have had a Pap test in
the last 3 years, but this difference was not significant (AOR=0.69; 95% CI=0.26-1.81).
Conclusions: The associations between financial hardship associated with medical costs and cancer screening
were observed among individuals who had at least one medical encounter in the past year, suggesting the need to
reduce barriers to cancer screening even among patients who already have some access to healthcare. Future
research should explore barriers related to both healthcare (e.g., co-pays) and personal costs (e.g., time off work)
as well as ways to increase the survey response rate.
Keywords: early detection of cancer; health care costs; colonoscopy; mammography; Papanicolaou test