• Unemployed Americans are far less likely to have insurance, and this lack of insurance accounts for lower cancer screening rates, according to a recent study.
• Lower screening rates disproportionately affect people of color who have higher rates of unemployment.
• Policies that ensure health insurance coverage and access to care for unemployed people may reverse the trend.

Unemployed American adults are far less likely to undergo potentially life-saving cancer screenings, according to a recent study published in the journal Cancer. Notably, screening rates are significantly higher for people who have health insurance, regardless of their employment status.

Led by Dr. Stacey Fedewa, a senior principal scientist in the Risk Factors & Screening Surveillance team at the American Cancer Society, the investigation found that unemployed Americans ages 50 to 64 were four times as likely to be uninsured as employed adults.

Dr. Fedewa and her team based their results on analysis of data from the 2000–2018 National Health Interview Survey, which included responses from 62,314 employed and 3,428 unemployed adults.

Unemployed Vs. Employed Cancer Screening Rates

Compared to employed adults, unemployed adults were less likely to be up-to-date on screening for various types of cancer:

• Cervical cancer — 78.5 percent of unemployed people were up-to-date on screening vs. 86.2 of employed people
• Breast cancer — 67.8 percent of unemployed people were up to date on screening vs. 77.5 percent of employed
• Colorectal cancer — 41.9 percent of unemployed vs. 48.5 percent of employed
• Prostate cancer — 25.4 percent of unemployed vs. 36.4 percent of employed

When health insurance was factored in, however, these differences disappeared. “I was not expecting insurance to fully account for the association,” said Dr. Fedewa. “Being unemployed at a single point in time may hinder longer-term screening practices, which may influence cancer outcomes.”

Previous research has also identified a link between insurance — or lack thereof — and cancer screening. One recent study, for example, found that Americans are more likely to be diagnosed with lung cancer once they reach age 65 and are eligible for Medicare.

Learn how to get insurance and/or financial assistance for lung cancer treatment.

Cancer Mortality Rates Remain Higher Among People of Color

Findings from Dr. Fedewa’s investigation showed that the proportion of unemployed was significantly higher among Black, Hispanic, Asian, and American Indian/Alaskan Native individuals than white individuals, suggesting that these populations are most affected by lack of screenings.

“Mortality rates for several cancers with screening tests are higher in Black persons overall, and for cervical cancer in Hispanic women,” said Dr. Fedewa. “Lack of access to care across the cancer continuum— from prevention to early detection to treatment — contributes to these disparities.”

A recent report from the American Lung Association also found racial disparities in survival rates for lung cancer and other key indicators that affect outcomes. The five-year survival rate for Black and Latino Americans was 18 percent and 19 percent compared to 22 percent for white Americans. The five-year survival rate is 23.7 percent overall. The report also found that early diagnosis rates for Black and Latino Americans were, respectively, 18 percent and 16 percent worse than white Americans.

Cancer Screening Saves Lives

According to the American Cancer Society, cancer deaths have declined in recent decades, and early detection has played an important role in the trend. For example, a study using data from Sweden indicated that women diagnosed with breast cancer who had regular mammograms had a 60 percent lower risk of dying from the disease in the 10 years after diagnosis and a 47 percent lower risk of dying from the disease in the 20 years after diagnosis compared to women who didn’t have regular screening.

Dr. Doug Owens, director of the Center for Primary Care and Outcomes Research in the Department of Medicine and School of Medicine at Stanford, stressed the importance of providing screenings to all populations, no matter their financial situation or insurance status.

“I think the main point of this study is that we need to try to make sure that people have access to and can avail themselves of these preventive interventions,” said Dr. Owens.

Learn more about the benefits of screening for early lung cancer.

Study authors highlighted that the impact of insurance and its interaction with unemployment is particularly important for colonoscopy, which is the most common colorectal cancer screening test in the United States.

“Colonoscopy requires specialty care, it costs more, and there’s more prep involved, so there may be more barriers for people who are uninsured to get this test,” said Dr. Fedewa.

Dr. Owens emphasized that colorectal cancer screening through colonoscopy is one of the most important preventive interventions that you can do.

“It’s particularly concerning if people don’t have access to colorectal cancer screening,” he said. “Now, there are alternatives to colonoscopy [such as stool testing], which would not require you to take a day off.”

As for a solution to the overall problem, the study authors concluded that expanding and ensuring health insurance coverage after job loss may “mitigate the COVID-19 pandemic’s economic impact as well as the impact of future adverse economic events on cancer screening.”