HEALTH care barriers were linked to lower cancer screening adherence across five major cancer types in a large U.S. cohort, with lower screening rates seen as obstacle burden increased.
Health Care Barriers and Cancer Screening
Researchers evaluated 160,691 screening-eligible adults from the All of Us Research Program to examine how access-related barriers were associated with adherence to recommendations for breast, cervical, colorectal, lung, and prostate cancer screening. The analysis drew on longitudinal data collected between 2017 and 2023 and included adults who met U.S. Preventive Services Task Force screening criteria for each cancer type.
Across cohorts, out-of-pocket costs, nervousness about seeing a clinician, and difficulty getting time off work emerged as some of the most frequently reported reasons for delayed care. Overall, at least one barrier was reported by 37% of those eligible for breast cancer screening, 50% for cervical, 28% for colorectal, 36% for lung, and 28% for prostate screening.
Screening adherence was modest overall, reaching 52% for breast cancer, 29% for cervical cancer, 54% for colorectal cancer, 16% for lung cancer, and 44% for prostate cancer. Rates declined steadily as the number of reported barriers increased. Among participants with three or more barriers, adherence fell to 44% for breast, 24% for cervical, 39% for colorectal, 10% for lung, and 35% for prostate cancer screening.
Barrier Burden Reduced Screening Adherence
In fully adjusted analyses, reporting three or more barriers was associated with significantly lower odds of adherence across all five cancer types. Compared with participants reporting no barriers, those with three or more were 29% less likely to meet breast cancer screening recommendations, 20% less likely for cervical cancer, 18% less likely for colorectal cancer, 32% less likely for lung cancer, and 26% less likely for prostate cancer.
Factor analysis also showed that barriers tended to cluster into three recurring domains: cost concerns, physical or logistical barriers such as transportation and distance, and competing obligations including work and caregiving. Cost concerns were associated with lower screening odds for breast, cervical, and colorectal cancer, while physical barriers were also linked with reduced adherence across those same screening programs.
Multiple Obstacles Need Multidimensional Solutions
The findings suggest that cancer screening gaps are not driven by a single issue, but by overlapping financial, logistical, and emotional barriers that can compound one another. The authors noted that interventions aimed at only one part of the problem are unlikely to be enough. Instead, improving cancer screening may require coordinated approaches that address affordability, transportation, work flexibility, and patient concerns at the same time.
The study was limited by reliance on electronic health record data from participating institutions and by the fact that only 48% of participants completed the health care access survey. Even so, the consistency of the results across sensitivity analyses strengthens the message that reducing barriers to care could play an important role in improving cancer screening uptake.
Reference
Gurayah AA et al. Barriers to health care and cancer screening. JAMA Netw Open. 2026;9(4):e267024.
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