The Relationship Between Social Risks and Cancer Screening Adherence Among U.S. Adults

Academic Background

Cancer screening is a critical tool for the early detection and prevention of cancer, significantly improving treatment outcomes and reducing mortality rates. However, despite recommendations from various U.S. health agencies for colorectal, lung, breast, and cervical cancer screenings, the adherence rates among eligible adults fall below the recommended targets. Screening adherence disparities are particularly notable among structurally marginalized populations. These disparities stem from complex social factors, including long-standing structural inequalities and social injustices, which pose significant challenges to public health and hinder the achievement of health equity.

To address these challenges, researchers have proposed various frameworks to understand and mitigate the factors influencing health outcomes and disparities, particularly those related to cancer. These frameworks encompass a range of interrelated factors, referred to as “social determinants of health” (SDOH), which shape an individual’s social risks (e.g., food insecurity, housing instability) and needs. While significant progress has been made in identifying and addressing SDOH, key gaps remain in pinpointing the specific drivers of screening nonadherence.

Research Origin

This study was conducted by Dr. Ami E. Sedani, Dr. Scarlett L. Gomez, Dr. Wayne R. Lawrence, Dr. Justin X. Moore, Dr. Heather M. Brandt, and Dr. Charles R. Rogers. The research team is affiliated with multiple institutions, including the University of Texas Health Science Center at Houston, the University of California San Francisco, the National Cancer Institute, and the University of Kentucky College of Medicine. The study was published on January 3, 2025, in the JAMA Network Open journal.

Research Design and Methods

Data Source and Study Participants

This cross-sectional study utilized 2022 data from the Behavioral Risk Factor Surveillance System (BRFSS), covering adult participants from 39 states and Washington, D.C. Eligibility criteria were based on the latest U.S. Preventive Services Task Force (USPSTF) cancer screening guidelines. A total of 147,922 individuals, representing 78,784,149 U.S. adults, were included in the analysis.

Social Risk Factors and Screening Adherence

The study assessed 10 social risk factors, including life satisfaction, social and emotional support, social isolation, employment stability, food security, housing security, utility security, transportation access, and mental well-being. Screening adherence was evaluated based on USPSTF definitions, and adjusted risk ratios (ARRs) with 95% confidence intervals (CIs) were estimated using modified Poisson regression models.

Research Findings

Sample Characteristics

The sample consisted of 65.8% women, with an average age of 56.1 years. Subsamples by cancer screening type included: colorectal cancer screening (CRCS; 119,113 participants), lung cancer screening (LCS; 7,398 participants), cervical cancer screening (CCS; 56,585 participants), and breast cancer screening (BCS; 54,506 participants).

Associations Between Social Risks and Screening Adherence

The study identified significant relationships between social risk factors and cancer screening adherence, with variations across screening types and gender. Specific findings include:

1. Life Dissatisfaction: Compared to individuals satisfied with their lives, those dissatisfied were more likely to not adhere to cervical cancer screening (ARR, 1.08; 95% CI, 1.01–1.16) and breast cancer screening (ARR, 1.22; 95% CI, 1.15–1.29).
2. Lack of Support: Lack of social and emotional support was linked to nonadherence for colorectal cancer screening in both genders and for breast cancer screening.
3. Food Insecurity: Food insecurity was associated with higher nonadherence for colorectal, cervical, and breast cancer screenings.
4. Transportation Insecurity: Transportation insecurity increased nonadherence to colorectal cancer screening among women and breast cancer screening.
5. Healthcare Cost Barriers: Cost as a barrier to healthcare access was linked to higher nonadherence for colorectal cancer screening (in both genders), lung cancer screening (women), and breast cancer screening.

Conclusion and Implications

This study revealed independent and differential associations between social risk factors and cancer screening adherence, with variations observed between genders. The findings emphasize the need to assess and address social risks to improve cancer screening adherence. Future research should focus on specific populations to develop effective interventions.

Key Highlights

1. Major Findings: Social risk factors such as food insecurity, transportation barriers, and cost-related challenges significantly influence screening adherence.
2. Innovative Methods: The study utilized recent BRFSS data and applied a modified Poisson regression model to ensure reliability.
3. Practical Implications: The results provide critical insights for public health interventions aimed at improving screening rates and advancing health equity.

Research Limitations

1. Self-Reporting Bias: Reliance on self-reported data may lead to misclassification risks.
2. Sample Limitations: The study excluded certain vulnerable populations (e.g., the unhoused and institutionalized), limiting the generalizability of findings.
3. Unmeasured Confounders: Factors such as immigration status, medical mistrust, and discrimination might influence the results but were not measured.

Future Research Directions

Future studies should further explore the complex relationships between social risk factors and screening adherence, particularly within specific subpopulations. Developing targeted interventions to address these social risks is essential for improving cancer screening adherence and health outcomes.

This study provides valuable insights into how social risk factors influence cancer screening adherence and outlines a roadmap for future public health efforts to address these disparities effectively.