Breast Cancer Screening Rates Research Articles

Barriers to and facilitators of breast, cervical and colorectal cancer screening and cancer screening histories of Métis people in Alberta, Canada

ABSTRACT Comprehensive evaluation of cancer screening activities based on individual experiences is urgently needed to address the burden of cancer among Métis people. In this co-designed and co-led study, a cancer screening questionnaire developed for Métis people to evaluate their cancer screening histories and to explore barriers and facilitators to cancer screening was used. Adult Métis Albertans were invited to participate in the anonymous survey through a multi-modal strategy used for community consultations. Descriptive analyses compared responses between regions, age groups and geographic locations. In total, 370 participants who identified as Métis consented and contributed responses between 12 September and 2 December 2022. Female respondents reported higher rates of cervical and breast cancer screening (>94%) and lower rates of colorectal cancer screening (67–78%). Most of the barriers and facilitators were rated as very important, especially access to reliable and accurate information on screening, risks and benefits of cancer screening, explanation of the test results or procedures, trust in their health care provider(s) and health care system and access to a primary health care provider. This study fills a crucial gap that can inform targeted interventions to increase cancer screening awareness and rates among Métis Albertans and reduce their cancer burden.

Identifying modifiable risk factors to improve immigrant breast cancer screening in the United States.

1530 Background: Despite marked reductions in breast cancer mortality since 1990, recent data suggest that progress has slowed—owing in part to plateaus in breast cancer screening in underserved populations. Historically low rates of screening coupled with rising breast cancer incidence make immigrants an important population for targeted intervention. Herein, we (1) compare contemporary rates of breast cancer screening among immigrants versus US natives; and (2) identify modifiable risk factors to inform the development of interventions to improve screening among immigrants in the United States. Methods: Using data from the 2019 and 2021 National Health Interview Surveys, screening eligible female participants (ages 40-79 years old) were identified, then classified by immigrant status as defined by nativity (US native vs. foreign-born). Primary outcome was receipt of screening mammogram in the last two years. Logistic regression models examined associations between immigrant status and mammography, with and without adjustments for age, metropolitan residence, overall health status, and survey year. Sequential analysis was then used to assess the degree to which modifiable social risk factors influence the magnitude of the association between immigrant status and mammography. Results: Of 20,090 female participants included in the study, 20% were immigrants. Compared to US natives, immigrants were less likely to have received a mammogram in the last two years (67% vs. 72%, aOR [95%CI], 0.87 [0.78-0.96], p=0.006)—an effect that was most pronounced among immigrant noncitizens (57%; 0.55 [0.47-0.64], p<0.001) but reversed among immigrants with US citizenship (74%; 1.14 [1.01-1.29], p=0.03). Of the factors assessed, having a usual source of care (5.73 [4.77-6.87]) or insurance (4.60 [3.74-5.67]) was associated with the greatest odds of biennial mammography, followed by educational attainment (1.38 [1.19-1.60]) and employment (1.19 [1.09-1.30]; all p<0.001). While having a usual source of care or employment attenuated—but did not eliminate—the association between immigrant status and mammography (0.87 [0.78-0.96], p=0.01 and 0.89 [0.80-0.99], p=0.03, respectively), this finding was not observed upon inclusion of insurance status or education in sequential models (0.97 [0.87-1.09], p=0.6 and 1.09 [0.96-1.21], p=0.13, respectively). With respect to insurance type, Medicare Advantage (4.60 [3.74-5.67]) conferred the largest benefit, followed by private insurance (4.54 [4.00-5.26]), Medicaid (2.63 [2.20-3.14]), and Medicare (4.39 [3.53-5.46]; all p<0.001). Conclusions: Breast cancer screening remains low in noncitizen immigrant populations. Targeted interventions to improve access to health insurance coverage and primary care for noncitizens may be most effective for improving rates of screening mammography among immigrants and thus warrant further investigation.

Cancer screening in sexual and gender minority populations: A systematic review and meta-analysis.

10540 Background: The sexual and gender minority (SGM) populations experience a greater cancer burden than their heterosexual or cisgender counterparts. Screening rates for cancer within this cohort are frequently suboptimal, highlighting notable deficiencies in screening recommendations. Inadequate culturally competent care and screening guidelines may contribute to delays in cancer diagnosis and treatment, ultimately impacting survival and quality of life. We sought to investigate the existing disparities in cancer screening among SGM populations. Methods: We conducted a systematic review and meta-analysis to assess the cancer screening rates in SGM. The SGM population included in this study were gays, lesbians, bisexuals, transgender men, and transgender women. Two reviewers conducted a systematic search of numerous databases, including PubMed, PsycINFO, and CINAHL, and then extracted relevant information from eligible studies. For this study, we conducted a meta-analysis using a random-effects model. Pooled estimates of the odds ratio were calculated for any combination of outcomes and population when at least two studies had relevant data. Study heterogeneity was assessed using I² statistics. Meta-regression, accounting for the study weight, year, and latitude, was performed on variables potentially associated with heterogeneity. Newcastle-Ottawa Scale was used to assess the quality of selected studies. Results: We analyzed data from a total of 60 eligible studies with 65,315 patients. Pooled analysis showed that sexual minority groups were at lower risk for cancer screening such as breast cancer screening (OR: 0.79, 95% CI, 0.75-0.82; Chi2=835.23; p<0.001; I2=97%), cervical cancer screening (OR: 0.62, 95% CI, 0.56-0.72; Chi2=926.23; p<0.001; I2=96%), colorectal cancer screening (OR: 0.51, 95% CI, 0.45-0.61; Chi2=3272.21; p<0.001; I2=98%), and prostate cancer screening (OR: 0.71, 95% CI, 0.63-0.82; Chi2=1282.92; p<0.001; I2=99%). The prevalence of lung cancer (p<0.001) and anal cancer screening (p<0.001) were also lower in sexual minority groups. The analysis also showed no small study effects (Egger test: 1.33; 95% CI: −5.42, −0.63; p=0.182). All the subgroups (geographical location, screening procedure, screening period) had high between-study heterogeneity. Conclusions: Our findings indicate that cancer screening rates for breast, cervical, colorectal, prostate, lung, and anal cell cancer are significantly lower in SGM populations and emphasize the urgent need for targeted interventions, culturally competent care, and inclusive screening guidelines to address these disparities. Understanding and addressing these issues are crucial for reducing delays in cancer diagnosis and improving survival and quality of life for SGM population. Further research and comprehensive strategies are warranted to bridge these gaps in cancer screening accessibility and uptake.

Demographics of cancer screening in Providence’s homeless population.

1585 Background: Adults experiencing homelessness have a higher incidence and mortality from cancer. It is estimated that almost 60% of homeless people in the US are from racial and ethnic minorities. Therefore, cancer mortality among the homeless may be an important disparity. In recent years homelessness has increased in Providence RI due to high rents and end of covid subsidies. The objective of this project was to learn about the demographics of the homeless population in Providence, focusing on risk factors for cancer and barriers to screening, to acquire the necessary information to develop interventions to improve cancer screening in the unhoused population. Methods: We conducted a cross-sectional survey of homeless individuals in Providence, RI. Survey data was obtained at homeless shelters, on the street, at soup kitchens and at other community events supporting the homeless. The largest single source of participants was those attending the Matthewson Street Church Friendship Breakfast on Sunday mornings. Results: Data was obtained from 278 homeless individuals from September 2023 to December 2023. 70% were male, 30% female. Age ranges included 28 (10%) < 40 years, 78 (28%) 40-49 years, 88 (32%) 50-59 years, 74 (27%) 60-69 years and 10 (4%) > 70 years. Race/ethnicity included 56% White, 18% Black, 13% Hispanic/Latino, 2% Native American, 9% multiracial and 2% other. 51% were sleeping in a shelter, 29% were unsheltered (including outside, car or tent), 12% “couch surfing”, and 7% were recently housed. Most participants (92%) had health insurance, the majority being state Medicaid, and had PCP visits (59%), mostly to community health centers, within the last 12 months. 72% of individuals were current cigarette smokers and 45% currently used alcohol. Among women, only 32% were on schedule for mammogram and 61% were on schedule for cervical cancer screening. Colon cancer screening rate for individuals > 45 years was 32%. Only 32% of males over 50 had prostate cancer screening. Barriers identified included needing to have other needs met such as food and housing, lack of transportation to healthcare facilities, and lack of awareness about the need to undergo screening. Conclusions: The most common age range of homelessness in Providence, ages 50-59, is when cancer screening should be ongoing. There is a higher incidence of homelessness among minorities. The homeless population have high risk factors for cancer but screening rates for breast, cervical, lung, prostate and colon cancer are well below national guidelines. This represents a health disparity. Given the proportion of participants with a PCP and health insurance, interventions to improve cancer screening in this population may be feasible. We plan to develop educational partnerships with community health centers during the next phase of this initiative to increase awareness and uptake of screening recommendations.

Expansion of outreach to native Hawaii and Pacific Islander communities to increase breast cancer screening and clinical trial awareness in underserved and rural Oahu.

e13725 Background: Multiple barriers exist in the enrollment of racial and ethnic minority groups into breast cancer screening and clinical trials. Such barriers include the lack of knowledge, mistrust, and access. To increase participation of rural-dwelling Native Hawaiian/Pacific Islanders (NHPI) and other underserved minority groups in breast cancer screening and clinical trials, a pilot project was developed to augment community engagement, provide education, and gain insights into the cancer screening/clinical trial process. Our objective was to engage rural Oahu's underserved communities in breast cancer screening and facilitate enrollment into the Digital Tomosynthesis Mammography and Digital Mammography in Screening Patients of Breast Cancer Trial (TMIST) utilizing a team comprising of a cultural congruent and gender concordant Community Health Educator (CHE) and medical oncology health care provider. Methods: We reviewed the community activities over the course of a year. The CHE facilitated outreach by speaking at numerous church events and other community gatherings. Results: Participants did not respond favorably to surveys on social determinants of health. Common reasons for their reluctance included lack of perceived importance and medical mistrust. When discussing verbiage that was intimidating or confusing such as clinical trial protocol consent language, TMIST study participants conveyed a strong sense of dehumanization. Conclusions: A total of 93 women were screened for the TMIST clinical trial. Of those, 13 were enrolled in TMIST and 31 participants received mammograms. Participant insight highlighted the importance of education using culturally sensitive language and community engagement to combat the lack of knowledge and mistrust. Continued development of education materials centered around community involvement will improve the accrual of NHPI participation in breast cancer screening/clinical trials. We hope this project established a basis for equity in communities with low breast cancer screening and clinical trial participation rates. We intend to build upon the community partnerships forged during this pilot project.

Behavioral Interventions to Improve Breast Cancer Screening Outreach

Despite public health efforts, breast cancer screening rates remain below national goals. To evaluate whether bulk ordering, text messaging, and clinician endorsement increase breast cancer screening rates. Two concurrent, pragmatic, randomized clinical trials, each with a 2-by-2 factorial design, were conducted between October 25, 2021, and April 25, 2022, in 2 primary care regions of an academic health system. The trials included women aged 40 to 74 years with at least 1 primary care visit in the past 2 years who were eligible for breast cancer screening. Patients in trial A were randomized in a 1:1 ratio to receive a signed bulk order for mammogram or no order; in a factorial design, patients were concurrently randomized in a 1:1 ratio to receive or not receive text message reminders. Patients in trial B were randomized in a 1:1 ratio to receive a message signed by their primary care clinician (clinician endorsement) or from the organization (standard messaging); in a factorial design, patients were concurrently randomized in a 1:1 ratio to receive or not receive text message reminders. The primary outcome was the proportion of patients who completed a screening mammogram within 3 months. Among 24 632 patients included, the mean (SD) age was 60.4 (7.5) years. In trial A, at 3 months, 15.4% (95% CI, 14.6%-16.1%) of patients in the bulk order arm and 12.7% (95% CI, 12.1%-13.4%) in the no order arm completed a mammogram, showing a significant increase (absolute difference, 2.7%; 95% CI, 1.6%-3.6%; P < .001). In the text messaging comparison arms, 15.1% (95% CI, 14.3%-15.8%) of patients receiving a text message completed a mammogram compared with 13.0% (95% CI, 12.4%-13.7%) of those in the no text messaging arm, a significant increase (absolute difference of 2.1%; 95% CI, 1.0%-3.0%; P < .001). In trial B, at 3 months, 12.5% (95% CI, 11.3%-13.7%) of patients in the clinician endorsement arm completed a mammogram compared with 11.4% (95% CI, 10.3%-12.5%) of those in the standard messaging arm, which was not significant (absolute difference, 1.1%; 95% CI, -0.5% to 2.7%; P = .18). In the text messaging comparison arms, 13.2% (95% CI, 12.0%-14.4%) of patients receiving a text message completed a mammogram compared with 10.7% (95% CI, 9.7%-11.8%) of those in the no text messaging arm, a significant increase (absolute difference, 2.5%; 95% CI, 0.8%-4.0%; P = .003). These findings show that text messaging women after initial breast cancer screening outreach via either electronic portal or mailings, as well as bulk ordering with or without text messaging, can increase mammogram completion rates. ClinicalTrials.gov Identifier: NCT05089903.

Exploring Disparities in Cancer Screening Among Women With Disabilities [ID 2683490

INTRODUCTION: Unequal access to health care for individuals with disabilities is an increasingly relevant disparity. Further, accessibility to cancer screening remains inadequate. Steele et al. (2017) reported a lower prevalence of women with disabilities undergoing screening for cancer versus women overall in the 2013 National Health Interview Study. The purpose of this study is to compare screening rates for breast, cervical, and colon cancer among female patients with and without disabilities within our health network. METHODS: The study is a retrospective review of patient charts between January 1, 2015 and January 1, 2020. Sample size calculations yielded need for 450 charts to achieve adequate power to detect a 10% reduction in each of the three screening rate analyses. Sample was drawn from electonic medical records and identified female patients ages 21–75 receiving gynecologic care at an eastern Pennsylvania health network. ICD-10-CM codes for disabilities identified patients with cognitive, mobility, speech, or hearing impairments. Statistical analyses included chi-squared goodness-of-fit tests. RESULTS: Cancer screening rates were significantly lower in the sample population. For cervical cancer, patients with disabilities had a 43.3% screening rate versus 66.0% in the general population. For breast cancer, the sample screened at 67.6% versus the general population at 75.0%. For colorectal cancer screening, the sample was at 54.8%, whereas the general population had a 66.0% screening rate (P&lt;.001). CONCLUSION: Understanding the mechanisms behind lower preventive care rates can help to improve health outcomes for this patient population. The future goal is to offer solutions to address disparities in cancer screening.

Association between the social vulnerability index and breast, cervical, and colorectal cancer screening rates in Rhode Island.

Cancer screening is effective in reducing the burden of breast, cervical, and colorectal cancers, but not all communities have appropriate access to these services. In this study, we aimed to identify under-resourced communities by assessing the association between the Social Vulnerability Index (SVI) with screening rates for breast, cervical, and colorectal cancers in ZIP-code tabulation areas (ZCTAs) in Rhode Island. This study leveraged deidentified health insurance claims data from HealthFacts RI, the state's all-payer claims database, to calculate screening rates for breast, cervical, and colorectal cancers using Healthcare Effectiveness Data and Information Set measures. We used spatial autoregressive Tobit models to assess the association between the SVI, its four domains, and its 15 component variables with screening rates in 2019, accounting for spatial dependencies. In 2019, 73.2, 65.0, and 66.1% of eligible individuals were screened for breast, cervical, and colorectal cancer, respectively. For every 1-unit increase in the SVI, screening rates for breast and colorectal cancer were lower by 0.07% (95% CI 0.01-0.08%) and 0.08% (95% CI 0.02-0.15%), respectively. With higher scores on the SVI's socioeconomic domain, screening rates for all three types of cancers were lower. The SVI, especially its socioeconomic domain, is a useful tool for identifying areas that are under-served by current efforts to expand access to screening for breast, cervical, and colorectal cancer. These areas should be prioritized for new place-based partnerships that address barriers to screening at the individual and community level.

Disparities in Study Inclusion and Screening Rates in Breast Cancer Screening Rates Among Transgender People: A Systematic Review

BackgroundBreast cancer screening trends of transgender and gender diverse (TGD) people remain largely unknown. This is concerning, as data are necessary to inform recommendations made by clinicians to their patients and by national guidelines to clinicians. The aim of this review is to explore the state of existing research literature and provide a summary report of current breast cancer screening rates in TGD adults. MethodsAll articles were identified using Medical Subject Headings terms. Inclusion criteria were all the following: (1) documents inclusion of at least one participant who identifies as a TGD person; (2) at least one TGD participant with top surgery or currently receiving estrogen-based gender-affirming hormone therapy; (3) results that report rates of breast cancer screening or mammogram referral. ResultsTwelve articles met inclusion criteria, six cross-sectional studies and six retrospective chart reviews. Three studies conducted secondary analysis of the Behavioral Risk Factor Surveillance System national dataset, and nine articles recruited their own sample with number of TGD participants ranging from 30 to 1,822 and number of cisgender women ranging from 242 to 18,275. Three studies found lower rates of screening in transfeminine persons receiving gender-affirming care compared with cisgender women; two studies found lower rates among TGD people compared with cisgender women; and three studies found no differences between the breast cancer screening rates of TGD and cisgender participants. ConclusionLimited studies recruit and report trends in breast cancer screening of TGD people. Those that do include TGD participants have mixed results, but overall TGD people had lower rates of breast cancer screening. More research is needed regarding breast cancer screening of TGD people to inform the development of protocols that ensure equitable access to preventative care.

Examining cancer screening disparities by race/ethnicity and insurance groups: A comparison of 2008 and 2018 National Health Interview Survey (NHIS) data in the United States.

Pervasive differences in cancer screening among race/ethnicity and insurance groups presents a challenge to achieving equitable healthcare access and health outcomes. However, the change in the magnitude of cancer screening disparities over time has not been thoroughly examined using recent public health survey data. A retrospective cross-sectional analysis of the 2008 and 2018 National Health Interview Survey (NHIS) database focused on breast, cervical, and colorectal cancer screening rates among race/ethnicity and insurance groups. Multivariable logistic regression models were used to assess the relationship between cancer screening rates, race/ethnicity, and insurance coverage, and to quantify the changes in disparities in 2008 and 2018, adjusting for potential confounders. Colorectal cancer screening rates increased for all groups, but cervical and mammogram rates remained stagnant for specific groups. Non-Hispanic Asians continued to report consistently lower odds of receiving cervical tests (OR: 0.42, 95% CI: 0.32-0.55, p<0.001) and colorectal cancer screening (OR: 0.55, 95% CI: 0.42-0.72, p<0.001) compared to non-Hispanic Whites in 2018, despite significant improvements since 2008. Non-Hispanic Blacks continued to report higher odds of recent cervical cancer screening (OR: 1.98, 95% CI: 1.47-2.68, p<0.001) and mammograms (OR: 1.32, 95% CI: 1.02-1.71, p<0.05) than non-Hispanic Whites in 2018, consistent with higher odds observed in 2008. Hispanic individuals reported improved colorectal cancer screening over time, with no significant difference compared to non-Hispanics Whites in 2018, despite reporting lower odds in 2008. The uninsured status was associated with significantly lower odds of cancer screening than private insurance for all three cancers in 2008 and 2018. Despite an overall increase in breast and colorectal cancer screening rates between 2008 and 2018, persistent racial/ethnic and insurance disparities exist among race/ethnicity and insurance groups. These findings highlight the importance of addressing underlying factors contributing to disparities among underserved populations and developing corresponding interventions.

Assessing the relationship between coverage of essential health services and poverty levels in low- and middle-income countries.

Universal health coverage (UHC) aims to provide essential health services and financial protection to all. This study aimed to assess the relationship between the service coverage aspect of universal health coverage and poverty in low- and middle-income countries (LMICs). Using country-level data from 96 LMICs from 1990 to 2017, we employed fixed-effects and random-effects regressions to investigate the association of eight service coverage indicators (inpatient admissions; antenatal care; skilled birth attendance; full immunization; cervical and breast cancer screening rates; diarrhoea and acute respiratory infection treatment rates) with poverty headcount ratios and gaps at the $1.90, $3.20 and $5.50 poverty lines. Missing data were imputed using within-country linear interpolation or extrapolation. One-unit increases in seven service indicators (breast cancer screening being the only one with no significant associations) were associated with reduced poverty headcounts by 2.54, 2.46 and 1.81 percentage points at the $1.90, $3.20 and $5.50 lines, respectively. The corresponding reductions in poverty gaps were 0.99 ($1.90), 1.83 ($3.20) and 1.89 ($5.50) percentage points. Apart from cervical cancer screening, which was only significant in one poverty headcount model ($5.50 line), all other service indicators were significant in either the poverty headcount or gap models at both $1.90 and $3.20 poverty lines. In LMICs, higher service coverage rates are associated with lower incidence and intensity of poverty. Further research is warranted to identify the causal pathways and specific circumstances in which improved health services in LMICs might help to reduce poverty.

The triad of knowledge, regular medical consultation, and recommendations for enhanced breast cancer screening intention in Morocco

Purpose The low rate of breast cancer screening in Morocco is linked to delayed diagnosis and increased mortality rates. Furthermore, there is a lack of research on the association between screening intention and knowledge levels. Our objective was to assess the level of knowledge regarding breast cancer and screening, identify the determinants of this knowledge, and determine predictive factors for screening intention.MethodsA cross-sectional analytical study was conducted on 1014 women in the city of Essaouira, Morocco, during the years 2018–2020. A stepwise logistic regression analysis was performed to identify the predictors using SPSS software.ResultsWe found an above-average level of knowledge (67%). These knowledge levels were associated with several personal characteristics. Moreover, these knowledge levels proved to be powerful predictive factors for the intention to undergo screening, along with regular medical consultations and recommendations to undergo screening.ConclusionWomen had a high level of knowledge about breast cancer and its characteristics. These knowledge levels were strongly associated with the intention to undergo screening. However, despite this, the low participation rate encourages the reinforcement of research to align knowledge, intention, and screening practices.

The Impact of Artificial Intelligence on the Uptake of Mammography Screenings in Women

This comprehensive review examines the role of artificial intelligence (AI) in influencing the uptake of mammography screenings in women. The review includes an analysis of peer-reviewed articles exploring the various aspects of AI's impact on breast cancer screening rates, accuracy, efficiency, patient experiences, and cost-effectiveness. Through this analysis, the review aims to shed light on the potential of AI to enhance breast cancer screening practices and outcomes.

Breast Cancer Screening Behavior among Working Women in Japan: Characteristics and Factors Inhibiting Screening.

Improving breast cancer screening rates is crucial for early detection. However, factors hindering regular screening among working women remain unclear. This study aimed to clarify screening behavior among working women in Japan and associated discouraging factors. Surveys were conducted from April to May 2019 among women aged 40-60 at public offices and companies in Tottori Prefecture. We used two surveys: the "Basic Attributes Questionnaire" and the "Structural Questionnaire on Rejecting Screening." Data analysis involved chi-squared tests, logistic regression analysis, factor analysis, and nonparametric tests. Completed questionnaires analyzed were 668 out of 825 collected (response rate: 81.0%). Most participants were part-time employees with an average age of 51 years. Over 60% reported undergoing regular screening. Logistic regression analysis identified part-time employment, lack of children, a discouraging workplace atmosphere, and absence of personal connections to breast cancer patients as factors associated with avoiding breast cancer screening. Factor analysis identified five factors and 16 items as reasons for not undergoing regular screening. Women who had no spouse, no children or felt that their workplace was not encouraging breast screening felt difficulty in scheduling screening most strongly. Individuals who had part-time employment and had no children, did not know a breast cancer patient, or considered that their workplace environment was not supportive were more likely to avoid undergoing regular breast cancer screening. Also, women who did not undergo regular screening experienced difficulty in scheduling. In the future, the challenge lies in disseminating accurate knowledge about breast cancer to foster awareness without excessive anxiety.

Advancing health equity in improving breast cancer screening with the use of a mobile mammography bus in marginalised population: quality improvement project

BackgroundBreast cancer, the second leading cause of cancer-related deaths in women in the USA, is effectively treated through early detection and screening. This quality improvement (QI) project aimed to improve...

County Mammogram Uptake can be Predicted from Social Determinants of Health, but Patterns Do Not Hold for Individual Patients.

The objective of this study is to describe patterns in barriers to breast cancer screening uptake with the end goal of improving screening adherence and decreasing the burden of mortality due to breast cancer. This study looks at social determinants of health and their association to screening and mortality. It also investigates the extent that models trained on county data are generalizable to individuals. County level screening uptake and age adjusted mortality due to breast cancer are combined with the Centers for Disease Controls Social Vulnerability Index (SVI) to train a model predicting screening uptake rates. Patterns learned are then applied to de-identified electronic medical records from individual patients to make predictions on mammogram screening follow through. Accurate predictions can be made about a county's breast cancer screening uptake with the SVI. However, the association between increased screening, and decreased age adjusted mortality, doesn't hold in areas with a high proportion of minority residents. It is also shown that patterns learned from county SVI data have little discriminative power at the patient level. This study demonstrates that social determinants in the SVI can explain much of the variance in county breast cancer screening rates. However, these same patterns fail to discriminate which patients will have timely follow through of a mammogram screening test. This study also concludes that the core association between increased screening and decreased age adjusted mortality does not hold in high proportion minority areas. The objective of this study is to describe patterns in social determinants of health and their association with female breast cancer screening uptake, age adjusted breast cancer mortality rate and the extent that models trained on county data are generalizable to individuals.

Exploring Disparities in Breast Cancer Screening: An Ecological Analysis of Australian Data.

The objective of this study is to analyse the socio-spatial patterns of breast cancer screening across Australian regions. The research is an ecological study. Data for breast screening participation and associated social and demographic factors are obtained from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics. The unit of measurement for the analysis is spatially aggregated regions (Statistical Area 3). Geographically weighted regression is used to analyse the relationship between a dependent variable and one or more independent variables while considering the spatial or geographic relationships among the data points. Globally, there was a significant (p<0.05) association between screening participation and income, English ability, education level, Indigenous background, and transport availability. The geographically weighted regression model represented an improved fit with a higher R2 (R2=0.89) and the Akaike information criterion (AIC) has improved, (AIC= 391.92). The Monte-Carlo tests for spatial variability were significant for all independent variables (p<0.05). Visually, there was marked spatial variation in the association between breast cancer screening rates and the significant independent variables from the global model. The identification of significant spatial variability in the association between breast cancer screening participation and important social and demographic factors provides important input into the design of programs aimed at increasing participation in screening regimes.

Breast Cancer Screening Among Females With and Without Schizophrenia

Breast cancer screening with mammography is recommended in Ontario, Canada, for females 50 years or older. Females with schizophrenia are at higher risk of breast cancer, but in Ontario it is currently unknown whether breast cancer screening completion differs between those with vs without schizophrenia and whether primary care payment models are a factor. To compare breast cancer screening completion within 2 years after the 50th birthday among females with and without schizophrenia, and to identify the association between breast cancer screening completion and different primary care payment models. This case-control study analyzed Ontario-wide administrative data on females with and without schizophrenia who turned 50 years of age between January 1, 2010, and December 31, 2019. Those with schizophrenia (cases) were matched 1:10 to those without schizophrenia (controls) on local health integration network, income quintile, rural residence, birth dates, and weighted Aggregated Diagnosis Group score. Data analysis was performed from November 2021 to February 2023. Exposures were schizophrenia and primary care payment models. Outcomes included breast cancer screening completion among cases and controls within 2 years after their 50th birthday and the association with receipt of care from primary care physicians enrolled in different primary care payment models, which were analyzed using logistic regression and reported as odds ratios (ORs) and 95% CIs. The study included 11 631 females with schizophrenia who turned 50 years of age during the study period and a matched cohort of 115 959 females without schizophrenia, for a total of 127 590 patients. Overall, 69.3% of cases and 77.1% of controls had a mammogram within 2 years after their 50th birthday. Cases had lower odds of breast cancer screening completion within 2 years after their 50th birthday (OR, 0.67; 95% CI, 0.64-0.70). Cases who received care from a primary care physician in a fee-for-service (OR, 0.57; 95% CI, 0.53-0.60) or enhanced fee-for-service (OR, 0.79; 95% CI, 0.75-0.82) payment model had lower odds of having a mammogram than cases whose physicians were paid under a Family Health Team model. This case-control study found that, in Ontario, Canada, breast cancer screening completion was lower among females with schizophrenia, and differences from those without schizophrenia may partially be explained by differences in primary care payment models. Widening the availability of team-based primary care for females with schizophrenia may play a role in increased breast cancer screening rates.

Breast cancer screening attitudes, beliefs, and behaviors of Zuni Pueblo women: identifying cornerstones for building effective mammogram screening intervention programs

PurposeBreast cancer is the leading form of cancer and has the second highest mortality rate of cancers for American Indian/Alaska Native (AI/AN) women. Early screening is critical. This study examines the breast cancer-related knowledge, beliefs, and behaviors of Zuni women in the Southwest United States (U.S.).MethodsIn 2020 and 2021, a survey was administered to better understand cancer screening patterns in Zuni Pueblo; 110 women from 50 to 75 years of age were recruited to respond to the breast cancer screening portion. Inclusion criteria included self-identifying as AI, a member of the Zuni tribe, or married to a Zuni tribal member, and meeting the age and gender requirements. Descriptive statistics and bivariate analyses were conducted examining the associations between measures of breast cancer knowledge, beliefs, and behaviors and breast cancer screening status (never, ever/non-compliant, and ever/compliant).ResultsOf survey participants, 47.3% have had a breast cancer screening and are up-to-date, 39.1% have had a screening in the past but are not up-to-date, and 13.6% have never been screened. Age was the only statistically significant socioeconomic predictor of breast cancer screening; the median (interquartile range) ages of each group are 62 (54, 68) ever/compliant, 56 (54, 68) ever/non-compliant, and 53 (51, 55) never (p-value < 0.001). Significant differences by health status and access to medical care include having a regular health care provider and going to see a provider for routine check-ups. The survey also shows differences in knowledge about breast cancer risk factors, beliefs, and behaviors. Women across all three screening statuses reported that they would get screened if encouraged by a health care provider.ConclusionWhile survey respondents report a relatively high rate of ever having had a breast cancer screening, less than half are compliant with screening guidelines, which shows there is an opportunity to improve breast cancer screening rates. With culturally tailored interventions, providers have the potential to improve breast cancer screening for Zuni women.

The association of Supplemental Nutrition Assistance Program (SNAP) benefits and breast, cervix, and colorectal cancer screening.

131 Background: Food insecurity is associated with healthcare access and utilization. The Supplemental Nutrition Assistance Program (SNAP) was created to reduce food insecurity for low-income households and hence may enhance health-seeking behaviors. However, it is unknown whether receipt of SNAP benefits is associated with rates of cancer screening. Our objective was to quantify the relationship of SNAP benefit receipt with cancer screening among low income individuals at high risk for food insecurity. Methods: The National Health Interview Survey (NHIS) provided by the Center for Disease Control and Prevention was utilized to identify high-risk adults ages 21 to 74 years eligible for screening for female cervix (21-65 years), colorectal (40-74 years), and/or female breast cancer (40-74 years). Data was included from the 2019 and 2021 surveys, with 2020 excluded due to limited cancer screening information. High-risk was defined as low or very low food security, household income &lt; 125% federal poverty level, or having Medicaid insurance. Up to date cancer screening was defined as receipt of mammography within 2 years for breast cancer; receipt of a cervical cancer test within 5 years for cervix cancer; and receipt of sigmoidoscopy within the past 5 years, colonoscopy within 10 years, fecal immunohistochemistry (FIT) testing within 1 year, or sDNA-FIT testing within 3 years for colorectal cancer. We utilized logistic regression to compare screening rates by receipt of SNAP benefits and accounted for the complex survey design of the NHIS. Models were adjusted for covariates including age, race, ethnicity, sex (colorectal cancer screening only), income, education, marital status, insurance status, metropolitan residence status, survey year, food insecurity, and comorbidities. Results: A total of 6,111, 4,141, and 7,015 respondents were identified for cervix, breast, and colorectal cancer screening analyses, respectively. Among these respondents, 67%, 61%, and 60% were up to date on cervix, breast, and colorectal cancer screenings, respectively. Among this high-risk cohort, 43% of respondents reported receipt of SNAP benefits. Receipt of SNAP benefits was associated with increased odds of cervical cancer screening (OR = 1.18, 95% CI = 1.00 – 1.39, P=.046), which was limited to females ages 21-39 (OR = 1.36, 95% CI = 1.05 – 1.77, P=.022). Receipt of SNAP benefits was not associated with increased rates of breast or colorectal cancer screening. Conclusions: Receipt of SNAP benefits is associated with higher rates of cervical cancer screening among low-income females at high risk of food insecurity, particularly among young adults. These data suggest that efforts to address social determinants of health may improve access to care.