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Prev Med. 2004 Mar;38(3):258-68.

Examination of population-wide trends in barriers to cancer screening from a diffusion of innovation perspective (1987-2000).

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Cancer Prevention Fellowship Program, Division of Cancer Prevention, and Health Communication and Informatics Research Branch, Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, MD 20892, USA.



Barriers to cancer screening may change over time as screening becomes more widespread.


Using 1987, 1992, and 2000 National Health Interview Survey data, we examined population-wide trends in barriers to Pap, mammography, and colorectal screening (n =66,452).


Lack of awareness was the most common barrier for all screening tests; it decreased by 13.5 percentage points for mammography and by 4.6 percentage points for colorectal screening, but increased by 3.0 percentage points for Pap test from 1987 to 2000. Decreases in not recommended by a doctor were observed for mammography (from 20.5% to 3.7%) and colorectal screening (from 22.3% to 14.2%). Examination of trends in barriers among sociodemographic and health care access subgroups revealed disparities for each screening test.


Although population-wide progress has been made in reducing barriers to screening, lack of awareness, and not recommended by a doctor remain important barriers, especially among traditionally underserved populations.

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