some barriers to increasing participation in cancer control exist at all socioeconomic levels, e.g., lack of information about cancer and about both the availability and the benefit of cancer screening. Fear of what might be found during such an examination mitigates against women either gaining information about cancer or doing something with the information once it is obtained. Other barriers … are more prevalent in low-income, medically underserved populations (Friedell, Linville, and Hullet, 1998, p. 1869).

These barriers are noted in Table 2-1.

Even after the diagnosis of cancer, not all groups of people are given the opportunity to receive the same quality of treatment. In one study reviewing lung cancer treatment patterns for more than 1,800 patients in New England hospitals, researchers found that more educated and privately insured individuals received more aggressive therapy than those without these attributes. In addition, people of lower SES seek health care more often in emergency room settings because they are underinsured or uninsured, which diminishes the continuity of care (Harvard Center for Cancer Prevention, 1996). This lack of proper and continuous care for individuals of lower SES subjects many to higher cancer mortality rates.

Tracing cancer disparities between groups of different SES continues

TABLE 2-1 Barriers to Optimal Cancer Screening, Diagnosis, and Treatment









Male dominance

Putting the family's needs above one's own


Fear that cancer will be diagnosed

Fear of the exam (e.g., mammogram and proctoscopy)

Acceptability of the service provided

Physical arrangements, visiting time

Hours of service

Staff attitudes

Language barriers

Cultural understanding by staff

Lack of continuity of care


SOURCE: Friedell et al., (1998), with additions by the study committee.

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