Transportation insecurity greatly reduces adherence to breast cancer screening
Key takeaways:
- Transportation insecurity reduced adherence to screening for breast cancer.
- Findings showed no link between transportation insecurity and adherence to screening for colorectal or cervical cancers.
Individuals with transportation insecurity appeared 41% less likely to undergo breast cancer screening than those without transportation difficulties, according to results of a cohort study.
Alexa L. Pohl, MD, PhD, general surgery resident in the department of surgery at Stanford University, and colleagues evaluated data on 25,417 adults (55% female) who participated in the 2018 National Health Interview Survey and were eligible for colorectal, breast or cervical cancer screening.
Adherence to 2018 U.S. Preventive Services Task Force screening recommendations for those three cancer types served as the study’s primary outcome. Researcher analyzed the outcome in relation to transportation insecurity and neighborhood social support.
Results showed 660 survey respondents (3%) delayed medical care due to a lack of transportation.
Fully adjusted models showed an association between transportation insecurity and adherence to breast cancer screening (OR = 0.59; 95% CI, 0.4-0.86) but not screening for colorectal cancer (OR = 0.87; 95% CI, 0.65-1.15) or cervical cancer (OR = 0.73; 95% CI, 0.46-1.13).
Neighborhood social support correlated with screening for colorectal cancer (OR = 1.12; 95% CI, 1.06-1.17) and breast cancer (OR = 1.13; 95% CI, 1.05-1.22), but not screening for cervical cancer (OR = 1.01; 95% CI, 0.93-1.1).
“We hope this will motivate medical providers to talk to patients about transportation when they offer mammography to a patient,” Pohl told Healio. “There has increasingly been a push within health care systems to screen people for social determinants of health, and there is a sort of fatigue — among both patients and providers — around getting through the screening questions. However, we want providers to know that it does matter.”
Healio spoke with Pohl about the rationale for the study, the implications of the findings and the next steps in research.
Healio: What impact does transportation insecurity have on access to cancer screenings?
Pohl: Most people who work in medicine are reading a lot about the concept of social determinants of health — structural issues that affect people’s health but might not appear to be directly related. We’re considering issues like food insecurity and housing insecurity or instability. Transportation insecurity is the same concept. If a person does not have a dependable, safe or timely way to get from place to place, it can affect a person’s ability to hold a job, pick up medications or make doctors’ appointments.
Healio: How did you conduct your study?
Pohl: We used a data set collected by National Center for Health Statistics, a branch of the CDC. Its primary purpose is to track things like health insurance status, tobacco use, cancer prevalence and other issues that affect the overall health of the American public. Different questions are included each year to explore ‘hot topics’ in health care, and we happened to find a year where they asked about transportation and cancer screening in the same use. We used this because it is broadly representative of the entire population of the United States.
Healio: What did you find?
Pohl: Breast cancer screening was associated with transportation insecurity, but we didn’t see the same relationship with screening for colorectal or cervical cancers. We need to do more research and ask more questions to find out why. Does it have to do with the demographics of people who are eligible for breast cancer screening? Does it have to do with the ease of the test? Both cervical and colorectal cancer can be screened in an office, if you’re already at an appointment. You don’t have to do anything extra to get these screenings. A mammogram entails a separate appointment. We don’t know the answer.
Healio: What did you find regarding social support?
Pohl: We looked at the impact of having social support, which means having friends, family members, neighbors or other people who offer assistance and support and can emotionally uplift the patient. We wanted to see whether that would increase cancer screening. We found that social support increased screening for colorectal cancer and breast cancer. That is a topic we hope to delve into further.
Healio: What are the potential implications of the findings?
Pohl: In the long term, I hope this can facilitate more conversation about the interventions we have to help with transportation issues. People with Medicaid have access to non-emergency medical transportation. This benefit can help people get to the doctor’s office or to a pharmacy to pick up prescriptions. However, this is delivered differently by state. I hope this raises the question of whether there is a way to make that system better for end-users so more people can use it and benefit from it.
Healio: What are the next steps in research?
Pohl: We are preparing a manuscript that is a systematic review looking at papers in which transportation and cancer screening or stage at diagnosis served as outcomes of interest. We want to see whether researchers are consistently finding that screenings are decreasing as people report transportation insecurity. We also want to see whether there is a connection between transportation insecurity and stage at diagnosis. Cancer screenings save lives through earlier diagnosis, faster treatment and better outcomes, so we want to evaluate that.
For more information:
Alexa L. Pohl, MD, PhD can be reached at alpohl@stanford.edu.
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