By Sara Stromberg, MPH(c)
Cancer is the second leading cause of death in the U.S. Early detection remains one of the most effective ways to reduce cancer-related illness and death. However, not all patients have access to routine screenings through traditional clinical pathways. Local health departments (LHDs) help fill this gap by expanding access to cancer screenings for uninsured, underinsured, and medically underserved populations. By connecting people to preventive services they might otherwise miss, LHDs extend the reach of primary care in communities.
Why Local Health Departments Matter
Local health departments approach health differently than traditional clinical visits because they consider the well-being of entire communities. LHDs combine clinical services with outreach, education, and community engagement to make preventive care more accessible for the entire community. Taking a population-level approach is imperative for cancer screening because widespread participation can reduce the overall burden of the disease.
Patients who rely on LHDs often face barriers tied to the social determinants of health (SDOH), including lack of insurance, transportation challenges, language differences, and limited health literacy. These barriers can lead to delayed diagnoses and poorer health outcomes. LHDs can help reduce disparities by offering low- or no-cost screenings alongside education and patient support.
LHDs may provide cancer screenings directly or coordinate referrals with hospitals, specialty providers, and federally qualified health centers. Services vary by county, but most Maryland LHDs support breast, cervical, and colorectal cancer screening through state-funded programs and local clinical partnerships. Some also expand access to other cancer screenings through collaborations with public, private, and community organizations.
Screening Programs Supported by Local Health Departments
In Maryland, the state Breast and Cervical Cancer Program (BCCP) partners with LHDs to provide mammograms, Pap tests, and follow-up diagnostic services to eligible individuals at little or no cost. Patient navigation is central to the program and allows individuals to understand their results, access follow-up care, and overcome barriers to completing treatment.
Cervical cancer is highly preventable through the HPV vaccination, timely screening, and follow-up. Unresolved infection with high-risk human papillomavirus (HPV) is the primary cause of cervical cancer, making both vaccination and early detection critical prevention strategies. Over the past decade, widespread Pap testing has dramatically reduced cervical cancer incidence and mortality. By reducing barriers to screening and follow-up, programs like the BCCP support early detection and improved outcomes for both breast and cervical cancers among underserved populations.
Colorectal cancer is another major focus for LHDs. It remains a leading cause of cancer death, with over 150,000 new cases and nearly 53,000 deaths expected in 20259. Screening can prevent many cases by identifying and removing precancerous polyps, yet more than one-third of adults 45 and older are not up to date on recommended screening. Maryland LHDs help improve access through stool-based tests like FIT or FOBT, colonoscopies, and outreach programs that bring testing to patients who might not otherwise seek care.
Advancing Health Equity Through Public Health Partnerships
Disparities in cancer screening persist across race, income, geography, and insurance status. While overall cancer mortality in the U.S. has steadily declined due to improved treatments and screening, cancer incidence continues to rise, and not all populations are affected equally.
Black, Hispanic/ Latino, and American Indian/ Alaska Native populations, people living in rural areas, and those with lower income or education face greater barriers to screening and early detection. This often leads to later-stage diagnoses and worse health outcomes. For example, Black adults are more likely to die from several cancers than White adults, despite similar incidence rates.
LHDs are uniquely positioned to address these disparities and expand access to preventive care by providing culturally responsive outreach, multilingual education materials, and patient navigation. Mobile clinics, community events, and partnerships with local organizations bring screenings to nontraditional settings, helping people overcome financial, transportation, or language barriers. Addressing these SDOH directly improves access to early detection and promotes equity.
For Family Physicians
Family physicians are essential partners in the success of public health screening programs and initiatives. Primary care providers (PCPs) are often the most trusted source of health information to individuals. This trust facilitates the effective recommendation of screening to patients who would otherwise be hesitant. Referrals from PCPs to local health department screening programs can prevent delays and promote continuity of care for patients who are uninsured, underinsured, or experiencing financial or access barriers.
Opportunities for Growth
Although LHDs have the potential to support cancer screening programs, they face ongoing challenges related to staffing constraints, limited funding, and administrative burdens that can hinder outreach and the implementation of critical programs. Workforce and resource capacity within local health systems declined significantly during the COVID-19 pandemic and have not fully rebounded. During this period, routine breast and cervical cancer screenings fell by approximately 85% at the pandemic’s peak.
LHDs and healthcare providers can work together to strengthen screening, referral, and follow-up efforts to address gaps in access to care. Providers should stay informed about local and state-level resources to make appropriate referrals for eligible patients. Additionally, they can support access for patients who do not meet income eligibility criteria by connecting them with low-cost screening options. Such resources include federally qualified health centers, hospital-based financial assistance programs, and nonprofit organizations that offer reduced-fee services. Expanding patient navigation, employing community health workers, and improving data sharing between public health and primary care systems can enhance outreach and follow-up.
Conclusion
Local health departments can drive cancer prevention by expanding screening services to populations that would otherwise be left behind. LHDs complement the role of family physicians and reinforce the importance of preventive care as a cornerstone of public health. Strengthening partnerships between providers and LHD can advance early detection, reduce cancer disparities, and improve outcomes across Maryland communities.
