New Research Shows How Social Factors Impact Low Breast Cancer Screening Rates

Breast cancer death rates have fallen nearly 60% since 1975, due in large part to improvements in screening. Not all women are taking advantage of the benefits of screening, though, and new research worked to identify the biggest reasons why.

A study recently published in Frontiers in Public Health looked at social determinants of health (SDOH) linked with breast cancer screening behavior in American women 40 and older. Social determinants of health are outside the realm of medicine and are generally spread across five categories: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. These include equitable access to cancer care, which has been shown to impact screening, as well.

After reviewing 72 studies on the topic published between 2013 and 2023, the researchers found that SDOH related to socioeconomic status were the most common factors impacting screening. Those included income, education level, employment status, birthplace/citizenship, number of years in the United States, marital status, social support, and number of children. The financial and work-related issues mirror recent research from the American Cancer Society and the National Cancer Institute, which found that breast cancer patients with a history of adverse financial events were more apt to be diagnosed at a later stage.

Race and ethnicity play a role, too. Minority women, other than those who identified as Asian, were found to have lower screening rates.

The team says addressing factors like this has been shown to turn the tide, as they can all impact disease outcomes.

The study authors write, “Over 30 different interventions that address SDOH increased breast cancer screening rates by 12.3%. Social determinants such as poverty, lack of education, neighborhood disadvantage, residential segregation, racial discrimination, lack of social support, and social isolation have shown in numerous studies to play a role in the breast cancer stage at diagnosis.”

Another common barrier, which may stem from socioeconomic issues, was healthcare access. Contributing factors in this area included insurance status and coverage, accessibility of health care services and providers, access to mammography facilities, and insurance copayments.

The study authors write, “Low affordability and healthcare accessibility profoundly impact breast cancer screening, leading to lower adherence in female patients. For instance, Medicaid patients who are required to pay co-payments for preventative services as well as for recommended follow-up visits are less likely to pursue such preventative services and mammograms are included in lost care. Co-payments of more than $10 have been associated with reduced rates of mammograms. Furthermore, a study investigating breast cancer screening among young military women revealed that, when removing cost and access barriers to obtaining a breast mammography, first-time screening rates were 90%.”

The researchers say that in order to improve screening rates, patient-provider communication should be improved, perceived discrimination should be addressed, health care system trust should be improved, structural efforts to improve health insurance coverage should be implemented, and language and transportation services should be addressed.

You can read the whole study here.