Patients with autism and other developmental disabilities are diagnosed with cancer at roughly the same rate as the general population, but they are far more likely to die from it, a disparity widely attributed to gaps in preventive care, delayed diagnosis, and barriers to treatment rather than to the disease itself.¹ Routine screening is one of the most effective tools for catching cancers early, yet prior research suggests it reaches this population unevenly. In one survey of adult women with autism, it was found that intellectual disability, communication difficulty, and non-independent living were all linked to going without having a Pap smear performed.² Understanding where screening falls short and where it does not can help health systems target outreach and accommodations to the patients most likely to be missed.
We studied more than 6 million U.S. adults who newly became eligible for breast, cervical, colorectal, or prostate cancer screening between 2022 and 2024, each followed for at least one year after becoming eligible. Patients were included if they had outpatient care before, during, and after the eligibility window and met age and sex criteria for the relevant screening type; those with a prior history of the corresponding cancer or related conditions were excluded. We compared the share of patients screened on time (within one year of first becoming eligible) between patients with autism and patients without autism. We accounted for demographics, social vulnerability and rurality based on recent address, census region, and eligibility year.
Patients with autism were less likely to be screened on time for most cancer types. Overall, patients with autism had a 35.6% lower likelihood of on-time screening than patients without autism, as seen in Figure 1. The largest gaps were for cervical cancer screening, where patients with autism had a 50.7% lower likelihood, and breast cancer screening, where they had a 28.7% lower likelihood; prostate cancer screening showed a smaller but still significant 14.9% lower likelihood.
Colorectal cancer screening was the exception to this pattern. Unlike the other screening types, patients with autism had a 12.1% higher likelihood of on-time colorectal cancer screening than patients without autism. This appears to be explained by how the screening was done: at-home, stool-based tests (FIT/gFOBT and sDNA-FIT) accounted for 46.2% of colorectal cancer screenings among patients with autism, compared with 37.6% among patients without autism, while in-clinic colonoscopy made up a correspondingly smaller share (52.5% versus 61.4%). Stool-based options can be completed at home without sedation or a procedural visit, which might lower barriers that depress screening rates elsewhere. Other screening methods (including sigmoidoscopy and colonography) were uncommon for both populations.
Because patients with autism tend to have more frequent healthcare encounters, we conducted a sensitivity analysis additionally adjusting for healthcare utilization to test whether differences in visit frequency accounted for the observed screening gaps. The overall pattern was unchanged, indicating that the lower screening rates among patients with autism are not explained by differences in how often these patients access care.
These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 307 million patient records from 2,000 hospitals and more than 49,000 clinics from all 50 U.S. states, Canada, Lebanon, and Saudi Arabia. This study was completed by two teams that worked independently, each composed of a clinician and research scientist. The two teams came to similar conclusions. Graphics by Brian Olson.
- Vuattoux D, Colomer-Lahiguera S, Fernandez PA, et al. Cancer Care of Children, Adolescents and Adults With Autism Spectrum Disorders: Key Information and Strategies for Oncology Teams. Front Oncol. 2021;10:595734. Published 2021 Jan 19. doi:10.3389/fonc.2020.595734
- Chen Y, Powers J, McDougle CJ, Zürcher NR, Thom RP. Cervical Cancer Screening and Prevention Uptake in Females with Autism Spectrum Disorder. J Autism Dev Disord. 2026;56(1):1-12. doi:10.1007/s10803-024-06565-2
