Remove the barriers keeping women from addressing colorectal cancer

This may be a month of fun and festivities with St. Patrick’s Day rolling right into March Madness, but it also commemorates two serious topics: women’s history and colorectal awareness. While the overlap may be purely coincidental, the timing appropriately underscores the need for improved awareness, screening and treatment for colorectal cancer, especially among women.

Though overall rates of new colorectal cancer cases have declined in the past decade or two, cases among people under 55 have increased about 1 percent to 2 percent each year since the mid-1990s, according to the American Cancer Society. In 2023, there were more than 150,000 new cases of colon and rectal cancers, including more than 70,000 cases in women.

Despite general improvements in colorectal detection, colorectal cancers were the second leading cause of cancer deaths in 2023. The Centers for Disease Control and Prevention reports that the colorectal cancer death rate was 12.6 per 100,000 people, and just slightly lower (10.5 per 100,000) in women. 

On its face, colorectal cancer may not seem like an obvious focus for women’s health advocates like myself. But the very keys to reducing colorectal cancer death rates — early detection and effective treatments — are often out of reach for millions of women in this country.

Colorectal cancer is treatable; the five-year survival rate is about 90 percent if found at an early stage, usually through a colonoscopy. But nearly 1 in 3 people in the United States are not up to date with their colorectal cancer screening, including nearly 27 percent of women. Screening rates are even lower among women ages 50 to 65, women with lower educational attainment and lower incomes, non-Hispanic Asian women, and women without a recent doctor visit or regular source of care. 

Part of the reason more people aren’t up to date may be basic: Colonoscopies are not especially fun. Anxiety over discomfort and unpleasantness may lead people to avoid the procedure. 

But cost and insurance coverage are also certainly deterrents. This is evidenced by the fact that uninsured women are among those with lower rates of colorectal cancer.

Lack of health insurance puts these already vulnerable women at even greater risk of not getting timely cancer screening. Women without insurance are less likely to use preventive services generally or to have a regular doctor or source of health care, per Kaiser Family Foundation data. Only 41 percent of women without health insurance reported having had a checkup or well-woman visit in the prior two years.

Even women with insurance face health cost barriers to screening and treatment. Nearly one-quarter (24 percent) reported difficulty paying medical bills in the past year. Of those, nearly half (48 percent) said that their medical bills made it hard for them to pay for necessities such as food, heat or housing.

Despite requirements in the Affordable Care Act (ACA) that insurers cover preventive care without patient cost-sharing, KFF reports that many women still say they have faced costs for checkups or well-woman visits. Nearly half (47 percent) of women with private health insurance and 20 percent of women on Medicaid — a program designed to significantly limit health care-related financial burdens for low-income people — said they had to pay something for a checkup. 

Colonoscopies, the gold-standard colon cancer screening method, are covered once every 10 years under ACA-compliant plans, but extra costs can creep in the form of facility fees, sedation or other procedures such as polyp removals. That’s not supposed to happen, but it can, turning a supposedly free test into a costly encounter. Lower-cost, less-invasive alternatives, such as stool tests and blood tests, are either already available or on the horizon, but may not be covered.

If preventive care presents these barriers — financial and otherwise — for so many women in the U.S., it is not hard to imagine how much harder it is to handle the burdens of treatment if they get a colorectal cancer diagnosis. 

Colorectal cancer costs an estimated $24.3 billion in annual national expenditures. Bringing national expenses down to an individual basis, one study showed that people with cancer spent more than $1,000 more on their out-of-pocket health care costs than people with no cancer diagnosis. 

Research conducted by my organization, Healthy Women, in 2021, illustrated just how costly cancer is for female patients and their caregivers. Cancer care creates true hardships through direct out-of-pocket treatment costs as well as indirect costs for transportation, caregiving, nonmedical supplies and lost wages.  

Another study showed that higher out-of-pocket costs were associated with a greater chance that patients would abandon or delay the start of their cancer medications, suggesting that financial barriers jeopardize health outcomes. 

We don’t just need to address financial barriers to current colorectal care screening and treatment, we need better treatments — and we need them now. New innovative medicines are critical to advancing health, yet scientific advancements specifically focused on and studied in women have historically lagged.

The Biden administration has taken important steps to invest in women’s health research and to improve access to and affordability of medications for more Americans. They need to put their money where their mouth is by allocating some of the recently announced $100 million for women’s health research to effective colorectal cancer treatment for women.

To truly improve the detection and treatment of colorectal cancer in women, we also need lawmakers, insurance companies and drug manufacturers to follow the administration’s lead in prioritizing the health of women.

Martha Nolan is a senior policy adviser at Healthy Women.