Health Matters: Despite clear value, many people delay or skip health screenings

This is the third of a five-part “Health Matters” series focused on health topics in South Snohomish County and sponsored by the Verdant Health Commission.

Read part 1 — “As county’s demographics change, immigrants struggle to access health care” — here and part 2 — “Area’s increasing density prompts gardeners to get creative growing in small spaces” — here.

When Peter Reckendorf’s friend advised him to get a colonoscopy, he was already nearly a decade older than the recommended age of 45.

Reckendorf, who has myriad medical conditions caused by dwarfism, had long been proactive about seeking health care. Even so, the procedure — and the liquid laxative he needed to drink in advance — felt daunting.

“Everyone talks about the prep,” said Reckendorf, a Lynnwood resident. “It didn’t sound like something I wanted to sign up for.”

Still, his friend’s personal experience with colon surgery resonated in a way the medical guidelines and statistics alone hadn’t, and he made an appointment. During the procedure, a doctor found – and removed—four polyps, or clumps of cells that can develop into cancer.

Hesitancy around colonoscopies is common, even though they’re one of the most effective preventative health measures, said local physician Allie Rosica of Bastyr Center for Natural Health. Indeed, colonoscopy screenings can reduce the risk of getting colorectal cancer by 52%, research has shown. More broadly, cancer screenings have given Americans about 12 million more years of life over the past 25 years, according to a 2023 study.

That number would be significantly higher if more people stayed up-to-date on recommended screenings, identifying issues before disease symptoms emerge. That’s why local health providers and community groups are emphasizing the importance of staying up-to-date on screenings and seeking preventive health care services.

“It’s a great time to go when nothing is wrong,” Rosica said. “The data is so strong on preventive health care.”

Why people skip screenings

The United States Preventive Services Taskforce (USPST), an independent volunteer panel of national experts, updates a list of screenings that apply to people at different life stages, such as during childhood, pregnancy or middle age. Some screenings are considered more effective than others in reducing the risk of negative health outcomes. For example, about 40% of new cancer diagnoses and a quarter of deaths among women come from three types of cancer: breast, colorectal and cervical cancer, according to the Centers for Disease Control and Prevention. There are screenings for those three cancers, all of which have a five-year survival rate of more than 90% if they’re diagnosed at an early stage.

Despite clear benefits, 43% of U.S. women reported skipping or delaying a recommended health screening, according to a 2024 survey of 4,000 women nationwide. Other recent surveys report similar findings: About half of U.S. adults skip health screenings, according to a 2023 study of 2,000 employed adults. People skip these regular checkups for a variety of reasons, ranging from “not thinking about it,” to fear of bad news and insurance issues. During 2020, screenings numbers dipped, though most services have since rebounded or exceeded pre-pandemic levels.

Locally, Edmonds-based Dr. Andy Perry, who works at the Community Health Center of Snohomish County, notices people skipping screening because they fear discomfort or simply can’t take the time off work. While many patients are familiar with vaccinations and mammograms, other useful preventive health screens like checking for high blood pressure and diabetes might not be on people’s radar. Sometimes, people get confused about which screenings apply to them, such as mistakenly thinking colonoscopies are only for men. Perry tries to discuss and address these concerns with his patients. But the appointments can feel too short, especially if someone comes in for acute conditions, he acknowledges.

“One of the barriers for me is that people have so many other medical issues that we don’t get to the preventive care part,” he said.

When people are feeling healthy, though, they often forego health care altogether, said Dr. Linda Strong, who works in primary care for Swedish Edmonds. Another system-level barrier is the shortage of primary care physicians, which can make it tough to make a new patient appointment.

For patients who have access and awareness, fear can be a powerful deterrent. Strong’s patients have shared stories of past pain, such as with a mammogram or a Pap smear. If that’s the case, Strong encourages patients to premedicate with Tylenol and discuss prior experiences with the person conducting the screen to see if the procedure can be modified. She’ll also discuss noninvasive options such as stool sample test for colon cancer.

Dismissing those recommended screenings entirely can lead to harmful health consequences. Once symptoms appear, a disease is typically harder to treat. In Strong’s own practice, she has had patients diagnosed in later stages of cancer as they deferred their own healthcare screening to care for a family member. Even though healthcare systems can text or email screening reminders, personal discussions about people’s hesitations, fears, and values tend to make the biggest impact, providers say.

“Sometimes, we talk about their family history, their goals for themselves, caring for their family, seeing their grandchild graduate,” Strong said. “That’s more important than a statistic.”

During those discussions, some patients have also shared how their culture influences their decisions to access health care. For example, some people are more reluctant to have their body touched due to a cultural emphasis on modesty. Other times, there might be a mismatch between a patient and the provider’s gender that’s preventing them from moving forward with health screens, she said.

Addressing cultural barriers, improving access

Addressing those barriers are critical given widespread disparities in screening rates. Cancer screening rates are generally lower among people of color, those with lower socio-economic status and people without health insurance, according to the American Cancer Society’s 2023 report on cancer disparities. For example, about 58% of people with a high school diploma report being up to date with colorectal screenings compared to nearly 78% of individuals with a college degree. About 74% of white people are up to date on that screening, while the percentages range from 60 to 72% for other racial/ethnic groups.

Those screening disparities resonate on a personal level for Ericka San Juan Pérez, who works with advancing health literacy for Lynnwood-based Latino Educational Training Institute. Among the local Hispanic community, people are often unsure where to go for screenings and whether they’ll be covered without insurance, she explained. Language can also be another barrier.

“There’s a fear that you’re going to ask for help and no one will speak your language,” she says. “There’s a fear that you’re going to get a bill and not be able to pay.”

That’s why the group organizes health fairs, bringing together partners like hospitals, public health agencies, and nonprofits to help underserved communities identify resources. Often, that firsthand outreach in someone’s native language can help dispel myths, such as the belief that there are no options for people without insurance.

Sometimes, San Juan Pérez might share her own family’s experience with foregoing preventative healthcare. Even though her mom insisted her father seek out regular screenings, her dad delayed the care. Ultimately, her brothers succeeded in accompanying him for a visit, which identified prostate cancer. Even though doctors removed a tumor, it returned, and he died in February at age 79.

“He was so fearful of the process,” she said. “It’s not a common practice in our culture to go to regular visits to the doctor. You can talk to individuals who never in their life visited a doctor or a dentist. People feel ashamed to ask for help: You don’t talk about these things.”

She uses that tragedy to help educate community members, such as a local woman who shared her fears about a painful lump in her breast. Without health insurance, she had been scared to seek a mammogram. San Juan Pérez shared upcoming dates for free mammogram screenings. The results came back negative, and the woman was able to schedule care to remove what turned out to be a benign mass.

When people dismiss screenings and say they’re healthy, San Juan Pérez pushes back, saying: “Yes, you’re probably doing great, but you never know when you might be sick. If you knew something bad was going to happen and you could prevent it, how would you react?”

Along with those personal conversations, accessibility also plays a significant role in reaching people. That means bringing health care to the places where people frequent, says Dena Constantine, Meadowdale High School’s Parent Resource Group’s president. Along with hosting a Community Health Foundation-run clinic, Meadowdale has invited heart screenings through the Nick of Time Foundation, a Mill Creek-based organization which aims to reduce sudden cardiac arrest among athletes.

Hosting screening events like that on campus creates a low barrier to participate and helps students whose parents might otherwise not be able to transport them to a healthcare setting, she said. Those events also help students see that preventative care is regular part of staying healthy, establishing a sense of comfort with screenings that can last through adulthood. The more people talk about preventive health care, the more it feels normal and less intimidating.

“Community influence is huge,” she said.

As a retired radiologic technologist, Constantine knows firsthand that perception matters. In decades of working with mammogram patients, she remembers how many patients were reluctant to undergo the screening procedure. One patient stands out in her memory for rescheduling five times out of fear. Afterward, the patient said the mammogram screening procedure itself was fine. Unfortunately, though, the results were positive, and she required surgical biopsy and radiation.

“Had she come sooner, we might have seen it when it was really tiny,” Constantine said.

Lesser-known screenings matter, too

While colon, breast and cervical screenings are more commonly known preventive tools, other health screens can also make a real difference in people’s everyday life. The Edmonds Waterfront Center offers vision and hearing screenings as well as a popular foot care clinic, said Michelle Reitan, the director of health and wellness programming.

During a foot care clinic visit, nurses address common yet often painful foot issues, such as corns, calluses, and ingrown toenails—and refer people who need additional assessment to a podiatrist or primary care provider.  At the clinic, nurses educate people about the importance of maintaining good foot care and wearing well-fitting shoes. Sometimes, simple fixes like adding foam around a toe can help with the uncomfortable rubbing that may limit someone’s daily activities.

A survey of 253 participants found that every single one reported their foot issues had improved, with one reporting: “I walked in with pain and I’m walking out pain free,” according to Foot Care Clinic Manager Kirsten Beck.

“Keeping your feet healthy is so important because foot pain will affect so much of your life; whether you’re able to stand, cook your meals, walk or exercise,” Beck said.

That rings true for Edmonds resident Linda Harter, who has received care for severe bunions. Having her feet in better shape helps her tackle the steep hill in front of her home that she walks daily. That exercise, which she does using mobile oxygen, helps her feel better despite having lung disease.

“My feet are in better shape to help me maintain this exercise that’s so important for my lungs,” said Harter, who was once an avid runner and a recreational soccer coach. “It means the world to me to stay as active as I can. We are more in control of our health than we realize, even when it changes.”

Screenings go beyond physical health, including mental health concerns like depression. Mental health care is one of the biggest steps Duke Nottingham has taken for his mental health. Nottingham, who travels to Edmonds for some of his care needs, pointed to mental health care as a key aspect of staying healthy. In recent years, the USPSTF recommended offering depression screens to most adult patients during primary care visits. Despite that expansion, some populations are often missed, including men and people over 75 years old, research has found.

Nottingham said he was long conditioned to “just be a man and deal with it.” Ultimately, though, he was able to address his mental health needs and receive treatment. He hopes more widespread identification of mental needs can help others access that critical healthcare.

“I know a fair number of men who have mental health disease and they suffer in silence,” he said. “I did the same for a long time. I just couldn’t do it anymore.”

Making a life-changing difference

Throughout the local community, there are numerous stories of people’s whose lives were changed thanks to screenings. Take Edmonds resident Natasha Ryan, a mom of two young children who had experienced breast pain several years ago. Even though her concerns were initially dismissed as hormonal, she persisted and sought out a mammogram.

Subsequent care, which involved a lumpectomy, also identified her as having an increased risk of breast cancer. Ryan now stays on top of scheduling regular mammograms and MRIs, and will begin a cancer prevention drug next month.

Without that initial screening, the lump could have developed into cancer, she said.  Now, she knows that she has to regularly monitor her health. She encourages others to do the same, taking advantage of screening tools.

“Now I’m super on top of it and proactive,” she said. “You have to advocate for your health. No one else is going to do it for you.”

Which cancer screenings are for you?

The Centers for Disease Control and Prevention supports screening for breast, cervical, colorectal (colon), as well as lung cancer screens for high-risk individuals.

Cervical cancer: Women should begin screening at age 21. If the Pap test result is normal, your doctor might advise waiting three years until the next one. Between 30 and 65, test every three to five years if you’ve received normal results (the time interval depends on the type of test used). After age 65, your doctor may advise no further screenings, depending upon your past history.

Breast cancer: The US Preventive Services Task Force recommends that women who are 40 to 74 years old and are at average risk for breast cancer get a mammogram every 2 years.

Colorectal cancer: The U.S. Preventive Services Task Force recommends that adults age 45 to 75 be screened for colorectal cancer. The decision to be screened between ages 76 and 85 should be made on an individual basis.

Lung cancer: Lung cancer screening is recommended only for adults who are at high risk for developing the disease because of their smoking history and age.

Source: CDC, USPST

Other health screenings to consider, such as blood pressure:

Other health screenings vary, depending upon someone’s age, sex and risk factors. To find your own customized list, explore My Health Finder, a government site that provides customized screening guidance by age and sex. For more information, check out this comprehensive list from the United States Preventive Services Taskforce.

Local resources for cancer screenings:

The Breast, Cervical, and Colon Health Program: This program provides free breast and cervical cancer screening to eligible people in Washington state, based on health insurance, income and age.  In Snohomish County, the program is run through Citrine Health.

The Fred Hutchinson Cancer Center Mammogram Van

Swedish Cancer Screenings

Providence Regional Cancer Partnership

— By Kellie Schmitt

Kellie Schmitt is an award-winning health reporter based in Edmonds. She covers health policy, public health and children’s health for a variety of publications including the Johns Hopkins University Public Health Magazine, ParentMap, and USC’s Center for Health Journalism. She has a master’s in science writing from Johns Hopkins University.

This series is supported by funding from the Verdant Health Commission. The My Neighborhood News Network maintains full editorial control over content produced as part of this series.