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43.6% vs. 75.5%. That is the colorectal screening gap no one is talking about. 🔬
For noncitizens in the United States, the odds of getting screened for colorectal cancer are less than half those of US-born citizens.
According to JAMA Network Open, a study of 131,501 eligible participants using National Health Interview Survey data from 2010 to 2023 found the following:
– Colorectal screening: 43.6% for noncitizens vs. 75.5% for US-born citizens
– Cervical screening: 57.1% vs. 71.6%
– Breast cancer screening: 73.0% vs. 80.1%
And the odds ratios tell an even starker story. Noncitizens had odds of 0.35 for colorectal screening, 0.41 for cervical, and 0.57 for breast cancer screening compared to US-born citizens.
📊 Cancer is the leading cause of death among noncitizens. And yet these screening gaps have persisted across the entire 13-year study window, in state after state.
This is not a patient behavior problem. It is a structural access problem.
What is driving it? The researchers ran mediation analysis and found that socioeconomic and healthcare access factors jointly explained 56.6% of the colorectal gap, 39.6% of the cervical gap, and a staggering 97.1% of the breast cancer screening gap.
Let me say that again. Nearly all of the breast cancer screening disparity is explained by poverty and lack of insurance access, not by anything inherent to the patient.
💡 Three perspectives every health system leader needs to hold at once:
The patient. She is eligible. She is at risk. She is not screening. Not because she does not want to, but because the system has not made it possible for her.
The provider. Ordering a screening is easy. Getting a noncitizen patient who is uninsured, may fear the system, and faces language barriers to actually complete it is a different challenge entirely.
The payer or health system. If you are not stratifying your eligible population by citizenship and insurance status and building targeted outreach protocols for noncitizen patients, you are leaving your most at-risk patients behind.
📋 A short checklist for closing this gap at an FQHC or community health center:
1. Segment your screening-eligible panel by insurance status and preferred language
2. Identify where noncitizen patients are falling out of the screening funnel
3. Build trust-first outreach using community health workers, not just appointment reminders
4. Remove financial barriers with sliding-scale or grant-funded screening programs
5. Track completion, not just referrals, by citizenship and insurance status
Save this if you run a community health program. The data is clear on where to focus.
At Oatmeal Health, we think about this every single day. Early detection only works if the people at highest risk are the ones getting screened. Right now, they are not.
The tools to close this gap exist. The will has to catch up.
👉 Follow Jonathan Govette, CEO of Oatmeal Health, for daily healthcare insights on LinkedIn. Deeper dives in The Oatmeal Bite on Substack: https://news.oatmealhealth.com
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Author:
CEO/Co-Founder @ Oatmeal Health | AI Lung Cancer Screening | Almost Became a Doctor | Engineer | Follow to Share What I’ve Learned Along the Way
I help patients get the care they need earlier, preventing late-stage cancer.
That’s been the throughline across three companies and almost 20 years in healthcare. At ReferralMD, we fixed broken referral networks so patients didn’t fall through the cracks. At Oatmeal Health, it’s lung cancer: building the diagnostic and screening infrastructure so the 85% of cases caught too late get caught early instead.
Today as CEO of Oatmeal Health, I lead a team embedding AI into radiology workflows to turn routine lung CT scans into reimbursable cancer risk assessments. We partner with FQHCs to reach underserved communities, and with health systems and payers to make early detection economically sustainable. Think HeartFlow or Cleerly, but for lungs.
Between companies, I advised at Techstars and Plug and Play, mentoring founders building in digital health. That experience shaped how I think about what separates companies that ship from companies that stall: distribution, reimbursement, and clinical trust, not just technology.
I’m a CancerX alumnus, a 3x healthcare founder, and someone who believes the biggest problems in cancer aren’t scientific. They’re operational.
We’re hiring mission-driven builders at Oatmeal Health. If you want to work on something that matters, reach out.
When I’m not working, I’m traveling, mentoring, and keeping up with one very energetic husky. 🐾
Substack – The Oatmeal Bite:
Millions of patients get less care because of who they are, where they live, or how they look. I’m fighting to change that. CEO @OatmealHealth, a startup built for the underserved. The Oatmeal Bite: intel for clinicians, investors, and advocates.
Jonathan Govette
CEO of Oatmeal Health
Substack:
https://oatmealhealthjonathangovette.substack.com/
