Demographic Disparities in Cancer Screening Willingness Among EmergencyDepartment Patients
Authors: Jo-Ann Rammal, Kayla Orow, Yasin Alrmi, Eva Quigley, Jeremiah Vidal, Keith
Bradley, Christian Loszewski, Jacob Manteuffel, Joseph Miller, Matthew T. Ball, Howard A.
Klausner
Objectives: To assess willingness to schedule cancer screenings among emergency
department (ED) patients not up to date on recommended screenings, identify
demographic factors associated with screening intention, and evaluate whether offering
scheduling assistance shifts willingness among initially reluctant patients.
Methods: This was a multicenter cross-sectional survey across 11 EDs in the National
Alliance of Research Associate Programs (NARAP) network. A convenience sample of
patients was surveyed by research associates from March 2017 to December 2025 on
screening history for four cancers, using fixed eligibility criteria: lung (age 55–80), breast
(females 50–74), cervical (females 21–65), and colorectal (50–75). Those not up to date
were assessed for likelihood of scheduling within 30 days on a five-point Likert scale, then for barriers and whether offering assistance would change their likelihood. Multivariable ordinal logistic regression evaluated associations between demographic variables (age, sex, race, ethnicity, education, insurance) and scheduling likelihood, with site as a fixed effect.
Results: Among 31,740 patients surveyed (median age 51, IQR 34–65; 57.5% female;
44.7% White, 29.6% African American/Black, 19.9% Asian American and Pacific Islander
(AAPI)/Other; 19.4% Hispanic/Latino), 1,087 were not up to date on mammograms, 1,941
on Papanicolaou (Pap) tests, 2,733 on colorectal screening, and 589 on lung (low-dose
CT). Within each group, willingness to schedule (likely/very likely) was highest for
mammograms (62.2%) and Pap tests (56.8%), followed by colorectal (49.5%) and lung
(36.7%). Older age was associated with lower willingness across all four screenings.
Relative to White participants, African American/Black participants had higher odds of
scheduling mammograms (OR 1.76, 95% CI 1.32–2.34), colorectal (OR 1.63, 95% CI 1.37–
1.94), and Pap tests (OR 1.25, 95% CI 1.01–1.56); Hispanic/Latino participants had higher
odds for colorectal (OR 1.33, 95% CI 1.06–1.67); and AAPI/Other participants had higher
odds for lung (OR 1.93, 95% CI 1.24–3.00) but lower odds for Pap tests (OR 0.79, 95% CI
0.62–0.99). The clearest disparities were socioeconomic. Versus a college degree, less
than a high school diploma was associated with lower odds of scheduling mammograms (OR 0.68, 95% CI 0.47–0.98) and colorectal (OR 0.59, 95% CI 0.47–0.74), and a GED/high school diploma with lower odds for colorectal (OR 0.67, 95% CI 0.56–0.81). Versus private insurance, no/other insurance was associated with lower odds of scheduling mammograms (OR 0.40, 95% CI 0.26–0.61), colorectal (OR 0.54, 95% CI 0.43–0.69), and Pap tests (OR 0.60, 95% CI 0.46–0.77); Medicare/Medicaid was associated with lower odds for mammograms (OR 0.64, 95% CI 0.50–0.82) and colorectal (OR 0.70, 95% CI 0.60–0.82). The most frequently endorsed barrier was an unspecified "other" reason (40–49% across screenings), followed by not being ready and lack of time. Among patients initially unlikely or unsure, offering assistance moved a substantial share into the likely/very likely range: Pap 34.4%, mammograms 24.4%, colorectal 22.3%, and lung 22.0%.
Conclusion: A majority of ED patients not up to date on breast and cervical cancer
screenings expressed willingness to schedule, though rates were lower for colorectal and lung. Willingness was higher among African American/Black and Hispanic/Latino patients, while the clearest disparities were by insurance and education; offering scheduling assistance further shifted many initially reluctant patients toward willingness. As these findings reflect stated intention rather than completed screening, the ED may nonetheless serve as a critical touchpoint to identify patients overdue for cancer screening and connect them to preventive care.
