Adults With Disabilities Face Gaps in Breast, Cervical, Colorectal Cancer Screening

Millions of US adults with disabilities who are eligible for breast, cervical, or colorectal cancer screening may be less likely to receive recommended testing, with the largest disparities observed among individuals reporting substantial self-care difficulties, according to findings from a recent analysis of nationally representative data.^1,2

The study, published in Cancer, evaluated screening patterns among adults with disabilities using pooled data from the 2021 and 2023 National Health Interview Survey (NHIS). Researchers examined screening according to 6 disability domains—vision, hearing, mobility, cognition, communication, and self-care—and 3 levels of difficulty: substantial, some, and none. Disability status and severity were defined using the Washington Group Composite Disability Indicator.

The analysis included 1712 individuals with disabilities eligible for breast cancer screening, 1147 eligible for cervical cancer screening, and 3106 eligible for colorectal cancer screening. When weighted to represent the US population, these groups corresponded to approximately 6.02 million, 5.10 million, and 11.17 million adults, respectively.

Self-Care Difficulties Linked to Lower Breast, Cervical Screening

The most pronounced disparities were observed among adults with substantial self-care difficulties, with screening rates for both breast and cervical cancer substantially lower than among those reporting no self-care difficulties.

For breast cancer screening, 52% of individuals with substantial self-care difficulties received recommended screening compared with 79% of those reporting no self-care difficulties. After adjustment, substantial self-care difficulty was associated with a lower prevalence of breast cancer screening (adjusted prevalence ratio [aPR], 0.69; 95% CI, 0.58-0.82).

A similar pattern was observed for cervical cancer screening. Screening prevalence was 37% among individuals with substantial self-care difficulties compared with 78% among those reporting no difficulties (aPR, 0.63; 95% CI, 0.51-0.78).

The analysis also found lower cervical cancer screening among individuals with substantial communication difficulties, with screening prevalence of 35% compared with 78% among those reporting no communication difficulties (aPR, 0.65; 95% CI, 0.52-0.82). Communication disability was not associated with lower breast or colorectal cancer screening.

Colorectal Cancer: Stool Testing More Common

Colorectal cancer screening showed a different pattern for stool-based testing. Adults with substantial mobility difficulties were more likely to report stool testing than those without mobility difficulties, at 22% and 16%, respectively (aPR, 1.24; 95% CI, 1.12-1.38).

Stool testing was also more common among adults with some self-care, mobility, and vision difficulties compared with those reporting no difficulty. These findings suggest that screening modalities that can be completed without an in-person procedure may help address some accessibility barriers for adults with disabilities.

Implications: Addressing Barriers to Screening

The findings highlight differences in cancer screening according to both the type and severity of disability. In particular, the low rates of breast and cervical cancer screening among individuals with substantial self-care difficulties point to a need for screening approaches that account for patients who may face challenges navigating or completing traditional screening services.

For clinicians, identifying barriers to screening may be particularly important for patients with greater functional limitations. The findings also suggest that offering accessible screening modalities, when clinically appropriate, could provide an additional strategy for improving participation. Self-sampling approaches, including stool testing, warrant further evaluation as potential strategies for improving screening access among this population, according to the authors.

“We know that individuals with disabilities have lower screening levels generally, but the magnitude of some disparities that showed up consistently gave cause for alarm, particularly for people struggling with self-care disabilities,” Priti Bandi, PhD, scientific director, cancer risk factors and screening surveillance research at the American Cancer Society and senior author of the study, stated in a news release. “The bright spot is at-home stool testing. It completely flipped the script on traditional disparities, clearing a potential path for making life-saving care accessible to everyone.”

Beyond individual and clinical barriers, advocates also emphasized the role of policy in expanding access to more accessible screening options.

“We must continue to advocate for policies that expand access to cancer screenings, including those that improve coverage for more accessible and innovative testing options, like at-home self-collection, and ensure adequate coverage for follow-up tests and treatment,” Lisa A. Lacasse, president of the American Cancer Society Cancer Action Network, added in the news release.

REFERENCES

1. Mazzitelli N, Star J, Meggett K, Han X, Bandi P. Prevalence of breast, cervical, and colorectal cancer screening among adults according to disability type and difficulty level, United States, 2021 and 2023. Cancer. 2026;132(18). doi:10.1002/cncr.70557

2. Breast, Cervical and Colorectal Cancer Screening Rates Significantly Lower for Millions of U.S. Adults With Disabilities, Research Shows. News release. American Cancer Society. September 10, 2026. Accessed September 11, 2026. https://tinyurl.com/3u4cespv