Health Insurance Status and Clinical Cancer Screenings Among U.S. Adults

Published:November 01, 2017DOI:


      Health insurance coverage is linked to clinical preventive service use. This study examined cancer screenings among U.S. adults by health insurance status.


      The Behavioral Risk Factor Surveillance System collected data on healthcare access and cancer screenings from 42 states and the District of Columbia in 2014. Data analyses were conducted in 2016. Participants’ health insurance status during the preceding 12 months was categorized as adequately insured, underinsured, or never insured. Primary type of insurance coverage was categorized as employer-based or Medicare (aged ≥65 years), self-purchased plan, Medicaid/Medicare (aged <65 years), and other public insurance. Clinical cancer screenings were assessed following the U.S. Preventive Services Task Force recommendations.


      Compared with adequately insured adults, underinsured and never insured women were 6% (p<0.001) and 41% (p<0.001) less likely to receive breast cancer screening, respectively; 1% (p<0.05) and 19% (p<0.001) less likely to receive cervical cancer screening, respectively; and 3% (p<0.01) and 47% (p<0.001) less likely to receive colorectal cancer screening, respectively; underinsured and never insured men were 6% (p<0.001) and 52% (p<0.001) less likely to receive colorectal cancer screening, respectively. Compared with adults with employer-based insurance/Medicare (aged ≥65 years), women with all other types of insurance were less likely to receive breast and cervical cancer screenings; women and men with self-purchased plans were less likely to receive colorectal cancer screening; however, men with other public insurance were more likely to receive colorectal cancer screening.


      Disparities in cancer screenings by health insurance status and type of insurance exist among U.S. adults. Greater efforts to increase screening rates and to reduce disparities in cancer screenings are an important strategy to help improve overall population health.
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      1. CDC. Health, United States, 2015. Table 19. Accessed December 22, 2016.

        • Sabatino S.A.
        • Thompson T.D.
        • Richardson L.C.
        • et al.
        Health insurance and other factors associated with mammography surveillance among breast cancer survivors: results from a national survey.
        Med Care. 2012; 50: 270-276
        • Sabatino S.A.
        • White M.C.
        • Thompson T.D.
        • et al.
        Cancer screening test use - United States, 2013.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 464-468
        • Amini A.
        • Jones B.L.
        • Yeh N.
        • et al.
        Disparities in disease presentation in the four screenable cancers according to health insurance status.
        Public Health. 2016; 138: 50-56
        • Farkas D.T.
        • Greenbaum A.
        • Singhal V.
        • et al.
        Effect of insurance status on the stage of breast and colorectal cancers in a safety-net hospital.
        Am J Manag Care. 2012; 18: sp65-sp70
        • Magge H.
        • Cabral H.J.
        • Kazis L.E.
        • et al.
        Prevalence and predictors of underinsurance among low-income adults.
        J Gen Intern Med. 2013; 28: 1136-1142
        • Schoen C.
        • DesRoches C.
        Uninsured and unstably insured: the importance of continuous insurance coverage.
        Health Serv Res. 2000; 35: 187-206
      2. CDC. Behavioral Risk Factor Surveillance System. Accessed December 22, 2016.

        • Mokdad A.H.
        • Stroup D.F.
        • Giles W.H.
        Public health surveillance for behavioral risk factors in a changing environment. Recommendations from the Behavioral Risk Factor Surveillance Team.
        MMWR Recomm Rep. 2003; 52: 1-12
      3. CDC. Statistical Brief on the Health Care Access Module, 2013 and 2014. Accessed December 22, 2016.

        • Dumont D.
        • Cooper T.
        • Jiang Y.
        Uninsurance is only half the problem: underinsurance and healthcare-related financial burden in RI.
        R I Med J. 2014; 98: 46-49
      4. U.S. Preventive Services Task Force. USPSTF A-Z Topic Guide Website. Accessed December 22, 2016.

        • Fox J.B.
        • Shaw F.E.
        Clinical preventive services coverage and the Affordable Care Act.
        Am J Public Health. 2015; 105: e7-e10
        • Shaw F.E.
        • Asomugha C.N.
        • Conway P.H.
        • et al.
        The Patient Protection and Affordable Care Act: opportunities for prevention and public health.
        Lancet. 2014; 384: 75-82
      5. Cohen RA, Martinez ME, Zammitti EP. Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2015. Accessed December 22, 2016.

        • Sommers B.D.
        • Gunja M.Z.
        • Finegold K.
        • et al.
        Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act.
        JAMA. 2015; 314: 366-374
        • Sommers B.D.
        • Blendon R.J.
        • Orav E.J.
        • et al.
        Changes in utilization and health among low-income adults after Medicaid expansion or expanded private insurance.
        JAMA Intern Med. 2016; 176: 1501-1509
        • Wherry L.R.
        • Miller S.
        Early coverage, access, utilization, and health effects associated with the Affordable Care Act Medicaid expansions: a quasi-experimental study.
        Ann Intern Med. 2016; 164: 795-803
      6. VA Office of Inspector General. Evaluation of colorectal cancer screening and follow-up in Veterans Health Administration facilities. Accessed December 22, 2016.

        • Long M.D.
        • Lance T.
        • Robertson D.
        • et al.
        Colorectal cancer testing in the national Veterans Health Administration.
        Dig Dis Sci. 2012; 57: 288-293