Abstract 7369: Self-reported barriers to healthcare and cancer screening rates: results from the All of Us Research Program
Authors: Kevin H. Kensler, Anjile An, Aaron Gurayah, Faith Morley, Meenakshi Davuluri, David M. Nanus, Bashir Al Hussein Al Awamlh, Rulla M. Tamimi
Journal: Cancer Research (2025)

Abstract Introduction: Identification of healthcare access-related factors linked to lower use of cancer screening can inform targeted policies and interventions to mitigate these barriers and ameliorate screening disparities. We evaluated how barriers to healthcare influence cancer screening rates for five cancer types in a diverse population. Methods: We identified cohorts of participants within the All of Us Research Program (2017-2022) meeting U.S. Preventive Services Task Force (USPSTF) guideline eligibility criteria for breast, colorectal, cervical, lung, or prostate cancer screening. Participants self-reported whether nine potential barriers had led them to delay seeking medical care in the past year. Using these items, a barrier burden was calculated by summing the number of affirmative responses (range 0-9), and exploratory factor analysis was performed to identify latent classes of barriers. USPSTF guideline-concordant receipt of cancer screening was assessed in the linked participant electronic health record. Multivariable-adjusted odds ratios (OR) were estimated for the association between each barrier, the barrier burden, and factor scores and receipt of cancer screening, accounting for participant sociodemographic characteristics. Results: Compliance with screening guidelines varied by cancer site: breast (42%, n=31, 827 eligible), cervical (28%, n=37, 770), colorectal (42%, n=68, 895), lung (11%, n=2, 737), and prostate (36%, n=8, 807). The most cited barriers were concerns about out-of-pocket costs, nervousness about seeing a provider, and inability to get time off work, though barrier frequency varied across cancer sites. Participants who were younger, female, had lower income or educational attainment, or identified as Hispanic or non-Hispanic Black were more likely to report 3+ barriers to care. Participants reporting 3+ barriers to care had lower screening rates relative to those who reported no barriers for breast (OR 0.66, 95% CI 0.60-0.72), cervical (OR 0.77, 95% CI 0.72-0.83), colorectal (OR 0.77, 95% CI 0.72-0.82), lung (OR 0.65, 95% CI 0.37-1.09), and prostate cancer (OR 0.78, 95% CI 0.64-0.95). Three latent factors were consistently identified across cancer sites reflecting cost concerns, logistical barriers (e.g. transportation), and competing obligations (e.g. time off work). In multivariable analyses, cost concerns were associated with lower screening rates for breast, cervical, and colorectal cancer, logistical barriers for breast, cervical, colorectal, and prostate cancer, and competing obligations for breast and prostate cancer. Conclusions: The cumulative burden of barriers to access and barriers related to cost concerns, logistics, and competing obligations were associated with lower cancer screening rates. Policies and interventions are needed to target multiple dimensions of access simultaneously to increase cancer screening uptake. Citation Format: Kevin H. Kensler, Anjile An, Aaron Gurayah, Faith Morley, Meenakshi Davuluri, David M. Nanus, Bashir Al Hussein Al Awamlh, Rulla M. Tamimi. Self-reported barriers to healthcare and cancer screening rates: results from the All of Us Research Program [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 7369.