In new research looking at the impact of socioeconomic factors on utilization of mammography screening, researchers found that women with an increasing number of unmet social needs were 38 percent more likely to be diagnosed with late-stage breast cancer.
For the prospective study, recently published in JAMA Network Open, researchers utilized the Health Leads Social Needs Screening Toolkit to survey 322 patients with stages I-IV invasive ductal or lobular carcinoma. The researchers said the screening survey was centered on questions about common social needs including topics such as housing instability, financial resource strain, utility needs, childcare accessibility, health literacy, food insecurity and transportation challenges.
The study cohort was comprised of Hispanic women (62 percent), non-Hispanic Black women (19 percent) and non-Hispanic White women (19 percent), according to the study.
Multivariable analysis revealed that those with an increasing number of unmet social needs were 26 percent less likely to have a screening mammography exam. For women with two or more unmet social needs, the researchers found that 33 percent had a late-stage breast cancer diagnosis in comparison to 13 percent with one unmet social need and 12 percent with no unmet social needs.
“ … Implementation of a social needs screening by social workers or community health workers may help identify specific barriers for patients that are addressable to not only identify but also increase preventative health behaviors and earlier detection in vulnerable populations that are at risk of having unmet social needs,” wrote lead study author Neha Goel, M.D., M.P.H., who is affiliated with the Department of Surgery within the Division of Surgical Oncology at the University of Miami, and colleagues.
The study authors also noted that women with late-stage diagnosis supported more children under the age of 18 (mean of 3.08) in contrast to those with early-stage diagnosis (mean of 2.6).
“Competing priorities such as caregiving, especially with less social support such as a spouse, may prevent utilization of screening mammography even if it is accessible. Our finding that insurance access was not significantly associated with screening mammography further highlights this point,” explained Goel and colleagues.
Three Key Takeaways
- Impact of social needs on late-stage breast cancer diagnosis. The study underscores a significant association between unmet social needs and late-stage breast cancer diagnosis. Women with an increasing number of unmet social needs were 38 percent more likely to be diagnosed with late-stage breast cancer, highlighting the crucial role of addressing social determinants in preventing advanced cancer stages.
- Social needs and mammography utilization. The research reveals a connection between unmet social needs and reduced utilization of screening mammography. Women with two or more unmet social needs were 26 percent less likely to have a screening mammography exam. This suggests that addressing social needs could potentially enhance preventative health behaviors and increase early detection through improved access to screening services.
- Possible impact of caregiving responsibilities on mammography screening behavior. The study highlights the influence of caregiving responsibilities on mammography screening behavior. Women with late-stage diagnoses supported more children under the age of 18, indicating that competing priorities, such as caregiving with less social support, may hinder the utilization of screening mammography, even when accessible. This emphasizes the need for tailored interventions considering individual circumstances and challenges.
The researchers also suggested that reduced language barriers between local clinicians and residents may have contributed to higher mammography screening rates for Hispanic women in comparison to previous literature.
“These findings may reflect our location in a majority-minority population geared toward Hispanics where access to care and utilization may be higher due to a large Spanish-speaking population among clinicians at our institutions,” noted Goel and colleagues.
(Editor’s note: For related content, see “What a New Mammography Study Reveals About BMI, Race, Ethnicity and Advanced Breast Cancer Risk,” “Study: Regular Mammography Screening Reduces Breast Cancer Mortality by More than 70 Percent” and “The Reading Room Podcast: Emerging Concepts in Breast Cancer Screening and Health Equity Implications, Part 2.”)
In regard to study limitations, the researchers acknowledged that women with ductal carcinoma in situ were not included in the study cohort. They also noted that possible response and recall bias may have affected the study findings.
