Differences in the time to implementation of evidence-based cancer control practices in the United States

Abstract Background Cancer mortality rates have consistently declined in the United States (US) in recent years, largely due to the implementation of evidence-based practices (EBPs) in prevention and early detection. However, the implementation of these practices has been slow, often taking over a decade to reach half of the eligible population. This study examined the national trends in time to implementation of four cancer-related EBPs across different US population subgroups and explored possible factors driving differences. Methods The National Cancer Institute’s Cancer Trends Progress Report (2022) and the National Health Interview Survey (NHIS) (2000–2018) provided data for this study. EBPs evaluated included: clinicians’ advice to quit smoking, colorectal cancer (CRC) screening, mammography screening and HPV vaccination. Time to implementation was conceptualized as the number of years between the publication of the first EBPs’ guidelines and their uptake by at least 50% of the eligible population. Subgroups considered were defined by race/ethnicity, education level and household income level. Using data from the NHIS, we conducted additional analyses for CRC screening and evaluated differences by racial/ethnic groups while considering the influence of other factors. Results No major differences by subgroups were observed for clinicians’ advice to quit smoking and HPV vaccination. Time to implementation varied by education for mammography; and by race/ethnicity, education and income for CRC screening. The associations between education and income with CRC screening were similar across racial/ethnic groups. In sequential analyses, the inclusion of SES indicators, time in the US, and US citizenship largely reduced the racial/ethnic differences in CRC screening over time. Conclusions We found differences in the time to implementation of cancer control EBPs. To reach and sustain national goals of increasing uptake of EBPs and reducing cancer mortality, efforts need to address the factors driving these differences.