Social Risks Lower Rates of Preventive Cancer Screenings
Cancer screening is crucial for early detection and improved prognosis. However, social risks, including food insecurity, housing instability, and transportation barriers, have been associated with lower rates of cancer preventative care. A recent study published in JNCI Cancer Spectrum investigated the pathways through which these risks affect screening outcomes for breast, cervical, and colorectal cancer (CRC) in patients served in community-based clinics across the US.
The study analyzed data from 186 clinics in 13 states between July 2015 and February 2020, focusing on patients eligible for breast cancer screening (ages 50 to 74), cervical cancer screening (ages 23 to 64), or CRC screening (ages 50 to 74. Patient-reported social risks were documented in electronic health records. Outcomes included whether patients were up to date on screenings at their initial visit, the percentage of subsequent study months they remained up to date, the receipt of screening orders, and the completion of those screenings. Multivariate analyses adjusted for demographic and socioeconomic variables such as insurance status, language preference, and poverty level.
Patients experiencing social risks were significantly less likely to be up to date on cancer screenings at their first clinic visit. Food insecurity was associated with a 3% to 6% reduction in the likelihood of being up to date across all cancer types, while housing instability reduced the likelihood by 6% to 8%. Transportation barriers had the most pronounced effect, with a 6% to 13% reduction in up-to-date status, particularly for CRC screenings. Social risks also influenced the completion of cancer screenings; however, breast cancer screening completion rates were not significantly impacted by any social risks, potentially due to the availability of outreach programs such as mobile mammography units. Additionally, food insecurity was consistently associated with a lower likelihood of receiving screening orders for all 3 cancer types, and a lower likelihood of completing screening orders for cervical cancer and CRC.
This study underscores the significant impact of social risks on cancer preventative care, particularly for CRC and cervical cancer screenings. “Future research should assess both how clinicians make decisions about cancer preventive care and how patients prioritize cancer screening in the context of social risks,” the researchers concluded. “As novel strategies and policies to mitigate social risks proliferate, it will be important to assess how these programs mitigate the complex pathways between social risks and cancer early detection services.”
Reference
Banegas MP, O’Malley J, Kaufmann J, et al. Social risk factors and cancer prevention care among patients in community health-care settings. JNCI Cancer Spectr. 2024;8(6)pkae115. doi:10.1093/jncics/pkae115
