Historical Redlining Bears a Mark on Present-Day Cancer Screening Rates

June 19, 2023 - Urban neighborhoods, once redlined by federal officials in the 1930s, are still haunted by the effects, as new research shows they face cancer screening disparities. 

Individuals residing in historically redlined areas face lower rates of breast, colorectal, and cervical screening compared to those in non-redlined areas. 

“Our study shows that the legacy of redlining has a long historical arc that still persists today due to chronic under investment in these areas,” said the lead study author Timothy Pawlik, MD, PhD, MPH, MTS, MBA, FACS, FRACS (Hon), a surgical oncologist who is the surgeon-in-chief of The Ohio State University Wexner Medical Center.  

“Redlining serves as a surrogate for systemic racism, especially as it pertains to those who live in areas that lack adequate investment in education, employment, transportation, and healthcare.” 

Redlining is a 20th Century practice that designated many inner-city, mostly Black neighborhoods as hazardous for housing investment. 

Under redlining, the US Home Owners' Loan Corporation (HOLC) implemented a four-tiered grading system for mortgage applications based on race or ethnicity. Neighborhoods received an "A" score for being considered the "best" and a "D" score for being labeled "hazardous" for mortgage lending. "D" neighborhoods often had a higher proportion of Black residents.  

This institutionally racist policy from the 1930s prevented families in predominantly Black or immigrant neighborhoods from accessing home loans and other financial investments for almost four decades. 

Consequently, residents in these low-rated neighborhoods were deprived of crucial financial resources and other essential social opportunities. This study, in particular, outlined differences in health screening rates forged by redlining. 

Researchers stated this is a stark wake-up call for targeted interventions to address and alleviate this burden. 

Among the 11,831 census tracts analyzed, a total of 3,712 tracts were identified as redlined, with the highest concentration of redlined tracts found in New York and California, particularly within the metropolitan areas of New York City and Los Angeles. 

Compared to non-redlined areas, redlined areas had 24 percent lower odds of meeting breast cancer screening targets, 64 percent lower odds of meeting colorectal cancer screening targets, and 79 percent lower odds of meeting cervical cancer screening targets. 

Importantly, this association persisted even after accounting for contemporary social vulnerability and access to care. 

Furthermore, the findings showed that redlining’s impact on cancer screening rates could be attributed to factors including poverty, limited education, and language barriers, highlighting their influence on healthcare disparities within redlined communities. 

“I find this study on the impact of historic redlining practices on current cancer screening rates to be incredibly important and sobering,” said David Tom Cooke, MD, FACS, professor and chief of the Division of General Thoracic Surgery at UC Davis Health, and president of the Thoracic Surgery Directors Association. 

“The findings clearly demonstrate that the legacy of redlining continues to contribute to significant disparities in breast, colorectal, and cervical cancer screening, highlighting the urgent need for targeted interventions and policy reforms to address underlying structural racism and improve health equity in our historically marginalized communities,” said Cooke. 

By understanding this and other interpersonal- and policy-level factors related to racial health disparities, healthcare leaders can begin to reshape their thinking. 

Efforts to improve cancer screening rates in historically redlined areas are gaining momentum through specific and actionable initiatives. To address the unique challenges faced by these communities, resident questionnaires could be utilized to identify potential barriers. 

For example, if transportation emerges as a hurdle, offering travel vouchers could enhance accessibility. Likewise, interpreter services may help organizations tackle language barriers.  

Researchers highlighted several approaches to boost cancer screening rates in these underserved areas. For starters, government policies could work to target areas with social services, such as poverty alleviation, affordable housing, and education. 

Additionally, organizations could implement initiatives to improve access to preventive cancer care and mitigate cancer screening disparities. 

Programs like the Mobile Mammography Van by the Navajo Breast and Cervical Cancer Prevention Program are making preventive care more accessible, helping bridge screening disparities, researchers pointed out. 

“I think the fact that the cancer screening is so disparate in these communities is a real wake-up call to all of us,” Pawlik said.