The Association Between Social Risks and Nonadherence to Cancer Screening Guidelines
What is the value in US adults addressing these risks, and how do social determinants of health play a role?
Routine cancer screenings are known to help with both early detection and prevention of cancers, especially more invasive ones. As a result, there is potential for lowering the risk of advanced-stage diagnoses, which could result in more negative clinical outcomes.
However, there continue to be differences in evidence-based adherence to cancer screenings, which is creating a disparity in the groups it affects—in this case, it’s disproportionately impacting “structurally marginalized populations.”1,2
Knowing this, a cross-sectional study published in JAMA Network Open sought to determine how social risks are connected to cancer screening guidelines enacted by the US Preventive Services Task Force (USPSTF).3
The study consisted of data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative, cross-sectional, randomized telephone survey that’s managed by the US Centers for Disease Control and Prevention (CDC). It gathers data on health-related risk behaviors and preventive health practices among noninstitutionalized US adults 18 years of age and older.4 In this particular case, the data itself were analyzed from Feb. 22-June 5, 2024, and featured individuals in 39 states and Washington, DC.
Overall, in the analysis, there was a total of 147,922 people included in the study that represented a weighted sample of 78,784,149 adults in the US. The breakdown featured 65.8% women, with a mean [SD] age of 56.1 [13.3] years). Subsamples consisted of 119,113 individuals that qualified for colorectal cancer screening (CRCS), 7,398 for lung cancer screening (LCS), 56,585 for cervical cancer screening (CCS), and 54,506 for breast cancer screening (BCS).
When it came to social contextual variables, there was an association between life dissatisfaction and nonadherence for CCS (adjusted risk ratio or ARR, 1.08; 95% confidence interval or CI, 1.01-1.16) and BCS (ARR, 1.22; 95% CI, 1.15-1.29). A lack of support was connected to nonadherence in CRCS in both men and women and BCS, along with a feeling of isolation in CRCS in women and BCS. The study authors found an association in feeling mentally distressed with BCS.
Pertaining to social determinants of health, economic stability specifically—there was an association between food insecurity and an increased risk of nonadherence in CRCS in men and women, CCS, and BCS. Meanwhile under human-made conditions, transportation insecurity was related to nonadherence in CRCS in women and BCS, while cost barriers to healthcare access were connected to a rise in risk of nonadherence in CRCS for men and women, LCS in women, and BCS. The highest risk and lowered accuracy was observed in LCS in women (ARR, 1.54; 95% CI, 1.01-2.33).
The study investigators concluded that, “This cross-sectional study of social risks and nonadherence to guideline-recommended cancer screening revealed variations by screening test and sex. The associations between cost barriers and nonadherence, for instance, emphasize the need for health policy reforms to ensure access to screenings. To improve access, clinicians should assess patients’ social risks and connect them with community resources. Further research targeting specific populations is essential before effective interventions can be implemented, as social risks may not always align with patient-centered social needs.”
References
1. Williams PA, Zaidi SK, Ramian H, Sengupta R. AACR cancer disparities progress report 2024: achieving the bold vision of health equity. Cancer Epidemiol Biomarkers Prev. 2024;33(7):870-873. doi:10.1158/1055-9965.EPI-24-0658
2. Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin. 2024;74(1):12-49. doi:10.3322/caac.21820
3. Sedani AE, Gomez SL, Lawrence WR, Moore JX, Brandt HM, Rogers CR. Social Risks and Nonadherence to Recommended Cancer Screening Among US Adults. JAMA Netw Open. 2025;8(1):e2449556. doi:10.1001/jamanetworkopen.2024.49556
4. National Center for Disease Prevention and Health Promotion. About BRFSS. Reviewed September 11, 2024. Accessed February 28, 2024. https://www.cdc.gov/brfss/about/index.htm
