The Table includes concepts in each area, with examples of how each can be applied to increase cancer screening in low-income and minority populations. We focus on 3 concepts from behavioral economics: judgment, decision-making, and choice architecture. Three concepts from behavioral economics - judgment, decision-making, and choice architecture - can enhance existing evidence-based screening strategies by providing new insights into the behavior of patients and clinicians and suggesting new tools and techniques to promote screening. Reaching the Healthy People 2020 goals in the face of persistent disparities requires new strategies for promoting screening tests. However, underserved populations continue to be screened at lower rates (1,6). As part of Healthy People 2020, the US Department of Health and Human Services has set ambitious screening targets (compliance of 70.5% for colorectal cancer screening recommendations, 93.0% for cervical cancer, and 81.1% for breast cancer). For cervical cancer, the USPSTF recommends screening for women aged 21 to 65 by Papanicolaou (Pap) test every 3 years women aged 30 to 65 may now choose a longer screening interval by combining cytology and testing for human papilloma virus (HPV) every 5 years (5).
The availability of several screening methods with different recommended intervals adds to the complexity of a patient’s decision to be screened for colorectal cancer. For colorectal cancer, the USPSTF recommends screening for adults aged 50 to 75 using colonoscopy, sigmoidoscopy, or fecal occult blood testing (FOBT) (4). The US Preventive Services Task Force (USPSTF) recommends that women receive screening mammography every 2 years from age 50 through 74 (3). This article explores how insights from behavioral economics may reduce these disparities by providing tools to increase screening for breast, colorectal, and cervical cancer.īreast, colorectal, and cervical cancer affect hundreds of thousands of Americans each year, and there is an evidence base for both supporting screening behavior and administering screening for all 3 of these cancer sites (3). Low-income, minority, and uninsured people in the United States are disproportionately affected by illness and death from cancer and have lower rates of participation in recommended screenings (1,2). We conclude by noting gaps in knowledge and propose future research questions to guide this promising area of research and practice. These recommendations include the use of incentives to increase screening, introduction of default options, appropriate feedback throughout the decision-making and behavior completion process, and clear presentation of complex choices, particularly in the context of colorectal cancer screening.
Finally, we offer suggestions about ways practitioners can apply principles related to choice architecture to health care systems in which cancer screening takes place. We describe how several behavioral economic principles involved in decision-making can influence screening attitudes, including how framing and context effects can be manipulated to highlight personally salient features of cancer screening tests. In the area of judgment, we describe ways practitioners can use the availability and representativeness of heuristics and the tendency toward unrealistic optimism to increase perceptions of risk and highlight benefits of screening. With an emphasis on the predictable, but sometimes flawed, mental shortcuts (heuristics) people use to make decisions, behavioral economics offers insights that practitioners can use to enhance evidence-based cancer screening interventions that rely on judgments about the probability of developing and detecting cancer, decisions about competing screening options, and the optimal presentation of complex choices (choice architecture).
Behavioral economics provides tools to potentially reduce disparities by informing strategies and systems to increase prevention of breast, cervical, and colorectal cancers. Persistent disparities in cancer screening by race/ethnicity and socioeconomic status require innovative prevention tools and techniques.
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