Increasing unmet social needs significantly linked to lower breast cancer screening rates

Key takeaways:

• Women with more unmet social needs had higher odds of late- vs. early-stage breast cancer at diagnosis.
• Not undergoing mammography was linked to Increasing unmet social needs and increasing age at diagnosis.

Women with unmet social needs are significantly less likely to undergo breast cancer screening and to have later-stage cancer at diagnosis even when free mammography is available, according to study results published in JAMA Network Open.

“Unmet social needs, such as housing instability, social isolation, food insecurity and transportation challenges directly affect a patient’s ability to access care and have been associated with poorer health outcomes,” Neha Goel, MD, MPH, associate professor of surgery in the division of surgical oncology at Sylvester Comprehensive Cancer Center of the University of Miami Miller School of Medicine, and colleagues wrote. “Individuals with cancer often report at least one unmet social need, especially within financial, informational, psychological and physical domains. However, there is a critical knowledge gap evaluating the impact of unmet social needs on utilization of screening mammography and breast cancer stage at diagnosis, particularly in high-income settings with access to screening mammography.”

Goel and colleagues conducted a prospective cohort study with data from 336 women with stages I to IV invasive ductal or lobular carcinoma who completed the Health Leads Social Needs Screening Toolkit. From 2020 to 2023, all women were treated at an academic medical center including both an underserved safety-net hospital and a National Cancer Institute-designated academic cancer center.

Primary outcomes were routine mammography screening and clinical breast cancer stage at the time of diagnosis.

Overall, 62% of women self-identified as Hispanic, 19% as non-Hispanic Black and 19% as non-Hispanic white. All women had access to city-funded mammography screening, and 76% of them completed a screening mammogram.

Women with two or more unmet social needs had a higher likelihood of presenting with late- vs. early-stage breast cancer (33% vs. 18%; P = .04). Women with unmet social needs in the domains of utility needs (17% vs. 5%; P = .004) or child care accessibility (12% vs. 3%; P = .02) had a higher likelihood of presenting with late- vs. early-stage breast cancer.

Women who presented at an underserved safety-net hospital had a higher likelihood of presenting with late- vs. early-stage breast cancer (31% vs. 18%; P = .04). Those who ever had a previous mammogram had a higher likelihood of presenting with early- vs. late-stage breast cancer (78% vs. 63%; P = .02).

Not completing mammography screening was associated with an increasing number of unmet social needs (OR = 0.74; 95% CI, 0.55-0.99; P = .047) and increasing age at breast cancer diagnosis (OR = 0.92; 95% CI, 0.89-0.96; P < .001). Researchers observed no significant association between a specific unmet social need and mammography screening utilization.

In addition, researchers noted that increasing unmet social needs were significantly associated with late-stage breast cancer diagnosis (OR = 1.38; 95% CI, 1.01-1.89; P = .04).

“By incorporating social needs screening into health care and developing interventions to overcome them, breast cancer outcomes can be improved. This study therefore reveals a need for integration of social needs screening measured in the health care setting to identify unmet social needs,” the researchers wrote. “In turn, partnerships between hospitals, social workers and communities should aim to develop targeted interventions to overcome barriers to screening utilization and unmet social needs to increase early-stage diagnosis, a direct mediator of improved survival outcomes, even in high-income countries with access to screening mammography.”