Behavioral Economics Can Help Improve Cancer Screening in Minorities
By: Sai Srihaas Potu
Persistent disparities in cancer screening by race and socioeconomic status require innovative prevention tools and techniques. Behavioral economics provides tools to potentially reduce disparities by creating strategies and systems to increase the prevention of breast, cervical, and colorectal cancers. With an emphasis on the predictable, but sometimes flawed, mental shortcuts people use to make decisions, behavioral economics offers insights that practitioners can use to enhance evidence-based cancer screening interventions that rely on judgments about the probability of developing and detecting cancer.
Low-income, minority, and uninsured people in the United States are disproportionately affected by illness and death from cancer and have lower rates of participation in recommended screenings. Breast, colorectal, and cervical cancer affects hundreds of thousands of Americans each year, and there is an evidence base for both supporting screening behavior and administering screening for all 3 of these cancer types.
In a recent study, researchers have described how several behavioral economic principles involved in decision-making can influence screening attitudes, including how framing and context effects can be manipulated to highlight personally salient features of cancer screening tests. Finally, they also offer suggestions about ways practitioners can apply principles related to choosing architecture to health care systems in which cancer screening takes place. These recommendations include the use of incentives to increase screening, the introduction of default options, appropriate feedback throughout the decision-making and behavior completion process, and clear presentation of complex choices, particularly in the context of colorectal cancer screening.
One suggestion that the researchers mentioned was sending messages. Messages about screening may also be framed to appeal to one’s sense of fairness. People who perceive the health care system as unfair are generally less trusting and less adherent to recommendations for preventive health behaviors such as cancer screening, though some exceptions to this finding have been noted. Addressing issues of trust and other barriers through improved communication, cultural competence, engagement in medical decision-making, and providing better information regarding screening options may improve screening in underserved populations.
Early detection of cancer greatly increases the chances of successful treatment. There are two major components of early detection of cancer: education to promote early diagnosis and screening.
Recognizing possible warning signs of cancer and taking prompt action leads to early diagnosis. Increased awareness of possible warning signs of cancer, among physicians, nurses, and other health care providers as well as among the general public, can have a great impact on the disease. Some early signs of cancer include lumps, sores that fail to heal, abnormal bleeding, persistent indigestion, and chronic hoarseness. Early diagnosis is particularly relevant for cancers of the breast, cervix, mouth, larynx, colon and rectum, and skin.
Based on the existing evidence, mass population screening can be advocated only for breast and cervical cancer, using mammography screening and cytology screening, in countries where resources are available for a wide coverage of the population. Several ongoing studies are currently evaluating low-cost approaches to screening that can be implemented and sustained in low-resource settings. For example, visual inspection with acetic acid may prove to be an effective screening method for cervical cancer shortly. More studies that evaluate low-cost alternative methods to mammography screening, such as clinical breast examination, are needed.
In the medical world, there is an ongoing debate about the extent to which regularly screening for cancer improves a person’s chances of survival if cancer is detected. In a new study, a research team from Sweden analyzed data collected from 52,438 women between the age of 40 and 69. Some of these participants opted to receive breast cancer screening over a 39-year period, in 1977–2015.
To improve the assessment of how organized breast screening initiatives would impact health outcomes, the experts who conducted the recent study used a new method that involved calculating the annual incidence of breast cancers leading to death within 10 years and within 20 years following diagnosis.
The investigators found that the women who had joined an organized breast cancer screening program had a 60 percent lower risk of death within 10 years following a breast cancer diagnosis. They also had a 47 percent lower risk of death within 20 years after a breast cancer diagnosis.
All the participants who were diagnosed with breast cancer, the investigators note, received the appropriate treatment for the cancer stage they were experiencing, in line with the most recent national guidelines at that time. The researchers believe that screening allows specialists to detect cancer tumors at an early stage, which means the tumors can be treated sooner, and they will respond better to therapy.
Cancer screening is an important part of overall healthcare. This is because the most effective way to survive cancer is to detect the disease at an early stage and eliminate it from the body before the cancerous cells spread to the rest of the body. There exist ways to identify the presence of cancer even before the disease starts manifesting itself in the form of symptoms.
Many individuals are hesitant to schedule cancer screenings for the fear of a positive result. People may sometimes choose to live in ignorance than acknowledge the reality of the presence of the disease in their bodies. Ignorance, however, does not cause the disease to go away – taking steps to eradicate the disease from the body is the only solution to the problem.
Colorectal cancer, breast cancer, and cervical cancer are major causes of illness and death in the United States that disproportionately affect low-income and racial and ethnic minority populations. The challenge of reducing, and ultimately eliminating, cancer-related health disparities is formidable, but tools from behavioral economics may move our efforts forward in meaningful ways by taking a realistic approach to human behavior and decision-making.
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2. Purnell JQ, Thompson T, Kreuter MW, McBride TD. Behavioral Economics: “Nudging” Underserved Populations to Be Screened for Cancer. Preventing Chronic Disease. 2015.
3. Sabatino SA, Lawrence B, Elder R, Mercer SL, Wilson KM, DeVinney B. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. American Journal of Preventive Medicine. 2012.