During the COVID-19 pandemic, millions of people missed recommended cancer screenings. Even in the absence of a pandemic, cancer is often diagnosed too late, and many people lack access to existing, proven, effective ways to screen for cancer as the result of a complex constellation of variables at different levels from the individual to society. To successfully achieve a return to pre-pandemic levels of screening will require a multifaceted approach to reach people for whom earlier diagnosis could mean a dramatically improved quality of life.
There are large differences in access to cancer screening and prevention based on gender, race and ethnicity, region and socioeconomic status. Meaningful progress against cancer for all will mean addressing these disparities and the underlying factors that contribute to them. Several ongoing Cancer Moonshot studies are evaluating approaches to improve the uptake of proven cancer screening modalities where they are underutilized, including telehealth and direct community engagement.
Research to improve screening includes the American Indian Colorectal Cancer Screening Consortium, which has implemented a patient navigation program using community, clinician and patient input2; the Accelerated Control of Cervical Cancer program, where a deep learning algorithm was employed to analyze cervix images captured using smartphones, providing a low-cost, practical way to screen for cervical cancer, especially in low-resource settings3; and a trial assessing single-dose efficacy of the HPV vaccine to prevent cervical cancer4.
Lack of health insurance is a known barrier to cancer screening that Moonshot researchers are addressing through technological solutions. Under the Implementation Science Centers in Cancer Control Program (ICS3), researchers developed an insurance support tool integrated into electronic health records to help community health center staff guide patients in enrolling for health insurance. Findings suggested that the tool can help increase cancer screenings and preventive care5. In another study, researchers found that implementing a rideshare transportation intervention after colonoscopy may improve colonoscopy completion rates6. The model, if successful, could be applied broadly to improve colorectal cancer screening rates in safety-net health systems (where care and resources are provided to uninsured, Medicaid and other vulnerable patients) and settings where procedural sedation is administered.
Screening is especially important for people known to be at greater risk for cancer because of inherited syndromes. As part of the Moonshot, researchers are developing a strategy for detecting hereditary breast and ovarian cancer and Lynch syndromes in broader populations. Those found to have these syndromes will be included in the study, and their relatives will be enrolled in cascade screening. Findings will have important implications for determining how best to screen and monitor these patients over time.