Study Identifies Key Factors to Women Missing Breast Screenings

A comprehensive review by researchers at Florida Atlantic University's Schmidt College of Medicine has identified critical social determinants of health (SDOH) that significantly impact breast cancer screening behaviors among women aged 40 and older in the United States.

The study, published in the journal Frontiers in Public Health, analyzed 72 peer-reviewed observational studies from 2013 to 2023, highlighting the influential factors contributing to low screening rates.

The review focused on various SDOH, including race/ethnicity, employment, education, food security, insurance status, housing, and access to quality health care. The researchers found that socioeconomic status-related factors were the most frequently identified obstacles. Key elements such as income, education level, employment status, birthplace, acculturation, marital status, social support, and the number of children were notably influential.

Access to health care emerged as a significant theme, appearing in 61% of the studies. Sub-categories within this theme included insurance status, accessibility of health care services, and providers, insurance coverage, access to mammography facilities, insurance co-payments, travel time to clinics, and county uninsured rates. Insurance status was the most reported factor, with many studies demonstrating a strong association between lack of health insurance and lower breast cancer screening rates.

"One of the most influential roles of social determinants of health lies within the realm of equitable access," said Lea Sacca, Ph.D., senior author and an assistant professor in the Department of Population Health and Social Medicine at FAU Schmidt College of Medicine. "Results from our research could inform future evidence-based interventions aimed at addressing the underlying factors contributing to low screening rates for breast cancer in the country."

Race/ethnicity, sex/gender, and sexual orientation also played crucial roles. The review found that 58% of the studies showed statistical significance in the social and community context category, with age and ethnicity being the most prominent sub-categories. Ethnic minority women, except those identifying as Asian, had a lower likelihood of being screened. Black women faced a higher risk of diagnosis upon first screening. Additionally, white bisexual women had significantly lower mammography rates compared to white heterosexual women, whereas bisexual Black women had higher rates than heterosexual Black women.

Language barriers were the third most significant issue, influencing screening behaviors. The study revealed that 38% of the reviewed articles found statistical significance in the economic stability category, with income level being the most common sub-categorical indicator. Women with estimated household incomes above $38,100 had higher repeat mammography rates compared to those with incomes below $25,399.

High levels of poverty and residence in impoverished rural regions were linked to lower screening rates. Food security also emerged as a crucial factor affecting mammography rates. "When women are forced to choose between feeding their families and pursuing preventive care, mammography becomes more of a luxury than lifesaving care," said Sacca. "Women facing food insecurity have a 54 percent lower likelihood of getting a mammogram."

Education access and quality were identified as strong indicators of mammography rates, with the highest level of education completed acting as the strongest sub-categorical factor. Other factors cited in the review included location, transportation, housing, county poverty rate, internet access, area deprivation index, diversity index, perceived discrimination, health beliefs, and trust in health care providers and systems.

The study suggests that improving patient-provider communication, addressing perceived discrimination, and building trust in the health care system are essential steps to enhance screening rates across all demographics. Structural efforts to improve health insurance coverage, language proficiency, and transportation services could also be beneficial. Community involvement is crucial to develop tailored educational campaigns emphasizing the importance of regular mammogram screenings.