Public awareness, adherence, and cost-effectiveness of cancer screening programs: Insights from national surveys (2015-2023).

Abstract

e13539 Background: Cancer screening programs are crucial for early detection and improved outcomes, yet disparities exist in adherence, awareness, and cost-effectiveness across regions and populations. Using data from the National Health Interview Survey (NHIS) and Behavioral Risk Factor Surveillance System (BRFSS), we evaluated public awareness, adherence rates, cost-benefit metrics, and barriers to cancer screening in the U.S. Methods: We analyzed NHIS and BRFSS data (2015-2023) on breast, colorectal, and cervical cancer screening adherence, assessing regional variations, healthcare access, campaign effectiveness, and primary care involvement. Cost-effectiveness was measured via incremental cost-effectiveness ratios (ICERs), quality-adjusted life years (QALYs), and return on investment (ROI). ROI was based on 200 public health campaigns (100 digital, 100 traditional). Barriers, including financial, logistical, and cultural factors, were also examined. Results: The study included 15,782 participants (mean age 55, SD = 12), 58.7% female. Racial composition: 61.7% White, 17.1% Black, and 13.3% Hispanic; 44.4% had private insurance. Screening adherence rates were highest for breast (72%), followed by cervical (73%) and colorectal (65%). Regional differences were significant, with breast cancer screening highest in the Northeast (72%) and lowest in the rural South (58%). Colorectal cancer adherence was higher in urban (69%) than rural (57%) areas, while cervical cancer compliance was greater in metropolitan (77%) vs. non-metropolitan areas (65%). Mammography was the most cost-effective screening ($23,000/QALY), followed by cervical ($27,500/QALY) and colorectal screenings ($32,000/QALY). Digital campaigns had a mean ROI of 2.32 (3.2:1 return), outperforming traditional outreach (ROI 1.49, 2.5:1 return). Screening adherence varied by race/ethnicity: White (74.3%), Asian (65.1%), Other (65.5%), Hispanic (63.4%), and Black (60.3%). Income strongly influenced adherence, with high-income (> $75K) individuals at 77.7%, middle-income ($35K-$75K) at 65.7%, and low-income (< $35K) at 50.7%. Barriers included financial constraints (38%), transportation issues (27%), and lack of awareness (22%). Conclusions: Despite established guidelines, significant disparities in cancer screening adherence and cost-effectiveness persist, associated with regional differences, socioeconomic, and healthcare access factors. Findings highlight that targeted interventions, such as mobile screening units in rural areas, integrated healthcare systems, and culturally sensitive public health campaigns, may improve adherence and reduce disparities. Future efforts should focus on addressing financial and logistical barriers, such as digital health interventions.