Box 1.

Challenges to Decreasing Disparities in Cancer Screening and Follow-up of Abnormal Screening Results

Patient Factors

Lack of insurance Under-insurance and uncovered costs Non-financial barriers Lower levels of knowledge Mistrust of health care Limited English proficiency Less self efficacy Lower health literacy Lack of a usual source of primary care

Practice Factors

Poor reimbursement for primary care, especially for publically insured patients who present at safety-net practices Competing demands during 15-minute visits Lack of resources to support team-based care such as patient navigators or community health workers Lack of adequate health information technology Lack of systems for referring uninsured patients to screening promotion programs (e.g., NBCCEDP)