A new study published this week in JAMA Network Open indicates that – even when women have access to breast screening – other factors can limit mammography’s life-saving impact. Researchers found that women with more unmet social needs had lower breast screening rates and higher rates of advanced disease – even if they had access to a mammography center.
Research into social determinants of health – the racial, demographic, and environmental factors that can affect the quality of a person’s health – have gained steam in the last several years.
- Numerous studies have found that racial and economic differences result in major disparities in healthcare outcomes – and some of the biggest variations occur in screening.
In the new study, researchers noted that unmet social needs can include housing instability, social isolation, food insecurity, and transportation challenges, and these needs can occur even in high-income areas with access to screening mammography.
- They studied the issue in Miami-Dade County, Florida, where all women 200% below the poverty line have access to no-cost screening mammography at safety net hospitals – in theory removing cost as a barrier to breast screening.
Researchers studied 336 women who filled out a survey on social needs; of these, 62% self-identified as Hispanic, 19% as Black, and 19% as White, and 76% had screening mammograms. Researchers found a lower odds ratio for getting a mammogram due to …
- An increasing number of unmet social needs (OR=0.74)
- Increasing age at diagnosis (OR=0.92)
Patients were also more likely to present with late-stage disease if they …
- Had two or more unmet social needs (33% vs. 18%)
- Had problems with their home utilities (17% vs. 5%) or childcare access (12% vs. 3%)
- Were presenting to a safety net hospital (31% vs. 18%)
The authors noted that although no single unmet social need was found to have a statistically significant impact on screening mammography rates, multiple needs piling up could “overwhelm” patients so they can’t find the time to schedule preventive health check-ups.
The Takeaway
The new findings offer a more complex view of breast screening disparities beyond just access to mammograms. Public health authorities and hospitals providing women’s health services may need to offer screening of at-risk patients and a broader range of services in order to make sure that the life-saving benefits of mammography are enjoyed on a wider – and more equitable – scale.
