IPM Take
Health systems keep calling people “non-adherent” when the pathway itself is inaccessible. The data on self-care, mobility, vision and communication difficulties show that screening design still assumes an able-bodied patient. The fact that stool testing reversed part of the colorectal gap is not incidental. It is an implementation lesson.
Executive Summary
An American Cancer Society study published in Cancer used nationally representative 2021 and 2023 U.S. data to examine breast, cervical and colorectal screening by disability type and severity. Weighted estimates represented 6.02 million adults with disabilities eligible for breast screening, 5.10 million for cervical screening, and 11.17 million for colorectal screening. Among people with substantial self-care difficulty, breast screening prevalence was 52% versus 79% among those without difficulty, while cervical screening was 37% versus 78%. In contrast, stool-based colorectal screening was 24% more prevalent among adults with substantial mobility difficulties than among those without mobility difficulty.
Why it matters
- Patients / advocates: Physical and communication barriers are still being translated into missed prevention.
- Public authorities: Accessibility needs to be designed into screening programmes, not bolted on afterward.
- Payers: At-home and self-collection options may reduce barriers, but diagnostic follow-up must also be covered.
- Clinicians: Screening recommendations are meaningless when the examination environment itself excludes the patient.
There is a lazy phrase in preventive medicine: “patients are not getting screened.”
This study asks a better question.
Can they?
For adults with substantial self-care limitations, breast screening fell from 79% to 52%. Cervical screening fell from 78% to 37%. Vision, mobility and cognitive difficulties were also associated with lower participation.
That is not simply behaviour. It is architecture.
Mammography machines are not equally usable by every body. Examination tables are not equally accessible. Appointment systems are not equally navigable. Communication is not equally adapted. Transport is not equally available.
Then comes the revealing exception.
Stool-based colorectal screening was actually more common among people with substantial mobility difficulties.
Why? Because the patient could do it at home.
Sometimes the innovation required to close an equity gap is not another biomarker. It is removing the door the patient cannot get through.
That lesson should travel beyond colorectal cancer. HPV self-collection, home-based testing, mobile screening, accessible equipment, transport support and adapted communication are not convenience policies. They are cancer-control policies.
The system cannot keep designing screening around the easiest patient to serve and then blaming everyone else for lower uptake.
