Cancer
State-specific and Socio-demographic Disparities in Breast Cancer Screening Among US Women mOHAMMAD eBRAHIMI kALAN* Mohammad Ebrahimi Kalan Ateeqa iJAZ Aditya Chakraborty Brett J. Sierra Mohan D. Pant Glenn A. Yap Brian C. Martin
Introduction
Breast cancer remains a leading cause of cancer death among American women. Early detection of breast cancer through screening plays a crucial role in facilitating more manageable and effective treatment. Here, we examined state-specific and socio-demographic disparities in adherence to the US Preventive Services Task Force (USPSTF) guidelines for breast cancer screening.
Methods
Data came from 105,833 US women aged 50-74 years who participated in the 2022 Behavioral Risk Factor Surveillance System and self-reported biennial mammography screening adherence as USPSTF recommended. Weighted frequencies were calculated to assess breast-cancer screening rates by US states, territories, and demographic factors. Multivariable log-binomial regression models were employed to estimate the factors associated with meeting USPSTF breast-cancer screening guidelines. Adjusted OR (AORs) with 95% CI were reported.
Results
Among women at average risk for breast cancer, 76.5% (estimated 36.7 million) met the breast cancer screening guidelines, with Rhode Island (85.9%) having the highest prevalence and Wyoming (65.2%) lowest prevalence among US states (Figure 1). Among those who met screening guidelines, 62.1% were in the age range of 50 to 64, 67.4% identified as non-Hispanic white, and 84.3% resided in metropolitan counties (urban vs rural). The regression model revealed that Hispanic (AOR=1.39; 95%CI:1.16-1.66; p=0.0004) and non-Hispanic Black (AOR=1.70; 95%CI:1.50-1.93; p<.001) women demonstrated greater adherence to USPSTF guidelines compared to their non-Hispanic White counterparts. Women with high school or above education (vs <high school; AORs ranged 1.43-1.78; ps<.05), those with an annual income of 35k and above (vs <35k; AORs raged 1.25-1.82; ps<.05) and insured (vs uninsured; AOR=3.95; 95%CI:3.23-4.83; p<.001) were more likely to adhere to the USPSTF guideline. Women who were American Indian or Alaska Native (AOR=0.61; 95%CI:0.42-0.89; p=0.01), had self-reported disability (AOR= 0.80; 0.73-0.88; p<.001) and avoided medical care because of cost (AOR= 0.61;95%CI:0.52-0.71; p<.001) were at greater risk of not adhering to the guideline. While retired (vs unemployed: AOR=1.27; 95%CI:1.04-1.54; p=0.01) women were more likely to adhere to the guideline, there were no significant differences among employed women or by their metropolitan counties (ps>0.05).
Conclusions
Over 75% of US women between ages 50-74 met breast cancer screening guidelines but with notable disparities. Hispanics and non-Hispanic Black women showed higher adherence, while lower education, income, cost-related medical care avoidance, and disability were linked to lower guideline adherence. Essential policy interventions are needed to ensure equitable access, early diagnosis, and, ultimately, to save lives through improved breast cancer screening.
