Cancer Screenings in Delaware

Delaware

Cancer has consistently remained one of the top two leading causes of death in the United States for over 75 years. Cancer screenings can help detect cancer early, when treatment is most effective. 

After lung cancer, breast cancer and colorectal cancer are the second- and third-leading causes of cancer death among women in the U.S. Among men, it is prostate and colorectal cancer. Both mammography and colorectal screening have been found to be cost-effective methods of reducing deaths from these cancers.

Despite their effectiveness in preventing cancers, mammography and colorectal cancer screening rates remain below national targets. Worsened by the COVID-19 pandemic, screening rates declined sharply during 2020. While they have increased since then, screening rates have not returned to pre-pandemic levels. 

Barriers to receiving cancer screenings include lack of insurance, inconvenient clinic hours, language barriers, mistrust in the medical system and lack of a usual source of care.

According to America’s Health Rankings data, the prevalence of cancer screening is higher among:

• Men compared with women.
• Those ages 65 and older compared with those ages 45-64.
• White and Black adults compared with Hispanic, Asian and American Indian/Alaska Native adults.
• Adults who are college graduates compared with adults with less than a high school education. 
• Adults with an annual household income of $50,000 or more compared with those with incomes less than $25,000.
• Straight adults compared with LGBQ+ adults. 
• Adults who have served in the military compared with adults who have not served.

In 2023, the United States Preventive Services Task Force (USPSTF) updated their recommendations for breast cancer screening, lowering the starting age of screening from 50 to 40 based on recent and more inclusive research. USPSTF now recommends that all women ages 40-75 be screened for breast cancer every other year. Current evidence is insufficient to assess if the benefits of mammography outweigh the harms for women ages 75 and older. Routine colorectal cancer screening is also recommended for all adults ages 50-75; for adults older than 75, it is an individual choice to be discussed with a doctor. 

The Community Guide lists evidence-based community-level interventions to increase cancer screening, including engaging community health workers, utilizing client reminders and incentives and educating patients in one-on-one settings. Text message-based interventions have been found to be effective for both client reminders and education. Additional strategies to increase cancer screenings include hiring patient navigators to guide people through the often complex and overwhelming health care system and providing financial incentives to encourage preventive care while addressing cost barriers. 

The Centers for Disease Control and Prevention’s Cancer Resources for Clinics and Communities provides evidence-based interventions for health care facilities that can help reduce structural barriers to cancer screening.

The Return-to-Screening Quality Improvement Project and Clinical Study has demonstrated significant increases in cancer screening volume at hospitals recovering from the impact of the COVID-19 pandemic.

Healthy People 2030 has several objectives regarding cancer screenings, including:

• Increasing the proportion of women screened for breast cancer.
• Increasing the proportion of adults screened for colorectal cancer.

American Cancer Society. “Cancer Facts & Figures 2023.” Atlanta, GA: American Cancer Society, 2023. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2023/2023-cancer-facts-and-figures.pdf.

Hall, Ingrid J., Florence K. L. Tangka, Susan A. Sabatino, Trevor D. Thompson, Barry I. Graubard, and Nancy Breen. “Patterns and Trends in Cancer Screening in the United States.” Preventing Chronic Disease 15 (July 26, 2018): 170465. https://doi.org/10.5888/pcd15.170465.

Joung, Rachel Hae-Soo, Timothy W. Mullett, Scott H. Kurtzman, Sarah Shafir, James B. Harris, Katharine A. Yao, Karl Y. Bilimoria, et al. “Evaluation of a National Quality Improvement Collaborative for Improving Cancer Screening.” JAMA Network Open 5, no. 11 (November 16, 2022): e2242354. https://doi.org/10.1001/jamanetworkopen.2022.42354.

Oakes, Allison H., Kelly Boyce, Catherine Patton, and Sanjula Jain. “Rates of Routine Cancer Screening and Diagnosis Before vs After the COVID-19 Pandemic.” JAMA Oncology 9, no. 1 (January 1, 2023): 145. https://doi.org/10.1001/jamaoncol.2022.5481.

Ran, Tao, Chih-Yuan Cheng, Benjamin Misselwitz, Hermann Brenner, Jasper Ubels, and Michael Schlander. “Cost-Effectiveness of Colorectal Cancer Screening Strategies—A Systematic Review.” Clinical Gastroenterology and Hepatology 17, no. 10 (September 2019): 1969-1981.e15. https://doi.org/10.1016/j.cgh.2019.01.014.

Rim, Sun Hee, Benjamin T. Allaire, Donatus U. Ekwueme, Jacqueline W. Miller, Sujha Subramanian, Ingrid J. Hall, and Thomas J. Hoerger. “Cost-Effectiveness of Breast Cancer Screening in the National Breast and Cervical Cancer Early Detection Program.” Cancer Causes & Control 30, no. 8 (August 2019): 819–26. https://doi.org/10.1007/s10552-019-01178-y.

Sabatino, Susan A., Trevor D. Thompson, Mary C. White, Jean A. Shapiro, Janet de Moor, Paul Doria-Rose, Tainya Clarke, and Lisa C. Richardson. “Cancer Screening Test Receipt — United States, 2018.” MMWR. Morbidity and Mortality Weekly Report 70, no. 2 (January 15, 2021): 29–35. https://doi.org/10.15585/mmwr.mm7002a1.