Current Prevalence of Major Cancer Risk Factors and Screening Test Use in the United States: Disparities by Education and Race/Ethnicity

Abstract

Overall cancer death rates in the United States have declined since 1990. The decline could be accelerated by eliminating socioeconomic and racial disparities in major risk factors and screening utilization. We provide an updated review of the prevalence of modifiable cancer risk factors, screening, and vaccination for U.S. adults, focusing on differences by educational attainment and race/ethnicity. Individuals with lower educational attainment have higher prevalence of modifiable cancer risk factors and lower prevalence of screening versus their more educated counterparts. Smoking prevalence is 6-fold higher among males without a high school (HS) education than female college graduates. Nearly half of women without a college degree are obese versus about one third of college graduates. Over 50% of black and Hispanic women are obese compared with 38% of whites and 15% of Asians. Breast, cervical, and colorectal cancer screening utilization is 20% to 30% lower among those with <HS education compared with college graduates. Screening for breast, cervical, and colorectal cancers is also lower among Hispanics, Asians, and American Indians/Alaska Natives relative to whites and blacks. Enhanced, multilevel efforts are needed to further reduce the prevalence of modifiable risk factors and improve screening and vaccination, particularly among those with lower socioeconomic status and racial/ethnic minorities.

An examination of socioeconomic and racial/ethnic disparities in the awareness, knowledge and utilization of three colorectal cancer screening modalities

“…In terms of utilization, none of our Asian participants had ever used mt-sDNA, likely a result of low awareness and knowledge of this modality. Contrary to our findings regarding other racial/ethnic minorities, black participants in this study showed comparable or higher levels of utilization of all three screening modalities when compared with non-Hispanic white participants, a finding consistent with other recent national surveys ( Goding Sauer, Siegel, Jemal, & Fedewa, 2019 ; Joseph, King, Dowling, Thomas, & Richardson, 2020 ). Historically, black populations had lower CRC screening rates than non-Hispanic white populations.…”

Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest

“…One of every 3 persons is expected to be diagnosed as having cancer in his or her lifetime, 1,2 with cancer ranking as the second leading cause of death in the United States. 3 Although cancer-related mortality has declined over the past few decades, substantial racial/ethnic, 4,5 rural, 4,6 educational attainment, 5,7 and socioeconomic 7,8 disparities remain. 9 Breast, cervical, and colorectal cancers are among the most frequently diagnosed cancers in the United States, and breast cancer and colorectal cancer are the second and fourth most prevalent causes of cancer-related deaths.…”

Leading cancers contributing to educational disparities in cancer mortality in the US, 2017

“…Cigarette smoking causes most lung cancers and profound educational disparities in smoking have been noted in the US [3]. National Health Interview Survey 2017 data indicate that 5.9% of people with a Bachelor's degree or more smoke vs. 24.9% of people with less than a high school education [4]. Lung cancer was the largest contributor to disparities in all racial/ethnic groups, except for Hispanic adults, likely due to smaller education-related disparities in smoking behavior within Hispanic populations than white populations [5,6].…”