Rates of screening for breast, cervical, and colorectal cancers are lower among millions of US adults living with disabilities than among those without disabilities, according to a new study published in Cancer.

“There are millions of individuals with disabilities who are eligible for cancer screening in the US today, and unfortunately, they are not receiving this preventive care to the degree that we might want,” said Priti Bandi, PhD, senior author of the study and scientific director of cancer risk factors and screening surveillance research at the American Cancer Society.

But the study also pointed to a promising path forward for some — at-home testing.

“On the flip side, we saw that more accessible ways of modalities of screening, such as home stool testing, was actually better in those with disabilities, suggesting an avenue forward in terms of how we might address this disparity,” Bandi told Medscape Medical News.

Bandi and her colleagues found at-home stool collection screenings for colorectal cancer were 24% more prevalent among people living with disabilities that substantially impaired their mobility, suggesting more adaptive screening methods could be an important option for certain populations.

To estimate cancer screening rates among people with disabilities, Bandi’s group used data from the 2021 and 2023 National Health Interview Survey, which included self-reported information about screening for breast, cervical, and colorectal cancers. The researchers also evaluated disability type, including vision, hearing, mobility, cognition, communication, and the ability to perform activities of self-care.

Rates of screening for all three tumor types were lower among people with disabilities, according to the researchers. People with difficulty caring for themselves at home experienced the sharpest disparities.

“Some of the magnitudes of the disparities were really striking for me,” Bandi said.

Among people without disabilities, the rate of cervical cancer screening was roughly 78%. But among people with substantial self-care disabilities, it fell to 37%.

“That’s a dramatic difference. You see that level of low screening only in those with no health insurance or no access at all,” Bandi said.

The disparities were steeper among people with substantial self-care disabilities, including those who reported “a lot of difficulty” or “cannot do at all” on at least one question about their functional abilities.  Compared with those without such disabilities, screening rates were 37% lower for cervical cancer, 31% lower for breast cancer, and 15% lower for colorectal cancer after adjusting for other factors.

People with other types of disabilities, such as impaired vision, mobility, and cognition, also had lower rates of screening for breast and cervical cancer.

“This study is not surprising, and I’m glad they did it,” said Willie Underwood III, MD, MSc, MPH, president of the American Medical Association. When caring for patients with disabilities, physicians may be more likely to emphasize preventive care for a person who has their basic needs met and is able to move through society easily.

When caring for patients with more severe disabilities, “the physician often focuses in on the care around their disability and often times forget those things like cancer screening,” Underwood said.

But people with disabilities still are at risk for cancer, Underwood said. “That’s what makes this study so important,” he said. “We can’t forget that, despite all the other things we’re managing.”

For Bandi, one of the most encouraging aspects of the study was the finding that rates of at-home stool sampling for colorectal cancer were higher among people with substantial mobility disparities than among those without mobility difficulty.

That method “could be a perfectly acceptable alternative for individuals with disabilities, particularly those with physical disabilities,” Bandi said.

The potential for more adaptive, at-home screening methods is massive, although for now, at-home testing kits for colorectal cancer and cervical cancer are among the only tests comparable in accuracy to conventional screening methods, Bandi said. Research on these more flexible screening methods is active and ongoing.

For now, Bandi said, physicians should “know that individuals with disabilities face these dramatic disparities, be more proactive about reaching out to patients who have the disabilities, and explore offering these at-home testing as a first step if they feel uncomfortable coming into the clinic.”

“We all deserve the right to have longevity,” Underwood said. “Having a disability should not mean your life expectancy is shortened.”

Bandi and Underwood reported no relevant financial conflicts to declare.

Sony Salzman is an Emmy-award winning journalist covering science and medicine. As an independent journalist, her work has appeared in The Atlantic, STAT News, NBC, Med Page Today, The Boston Globe, Al Jazeera, VICE, and WBUR.