Jorge Kaufmann

Social risk factors and cancer prevention care among patients in community health-care settings

Abstract Background Social risks are negatively associated with receipt of cancer preventive care. As knowledge is lacking on the pathways underlying these associations, we investigated associations between patient-reported social risks and colorectal cancer (CRC), cervical cancer, and breast cancer screening order provision and screening completion. Methods This study included patients eligible for CRC, cervical cancer, or breast cancer screening at 186 community-based clinics between July 1, 2015, and February 29, 2020. Outcomes included up-to-date status for indicated cancer screenings at baseline; percentage of subsequent study months in which patients were up-to-date on screenings; screening order receipt; and screening completion. Independent variables were patient-reported food insecurity, transportation barriers, and housing instability. Analyses used covariate-adjusted generalized estimating equation models, stratified by social risk. Results Patients with documented social risks were less likely to be up-to-date on any cancer screening at baseline and in most cases had a lower rate of total study months up-to-date on screenings. All cancer screenings were ordered less often for food-insecure patients. Cervical cancer screening was ordered less often for transportation-insecure patients. The likelihood of completing a screening test differed statistically significantly by select social risks: Cervical cancer and CRC screening rates were lower among food-insecure patients, and CRC screening rates were lower among transportation-insecure patients. The likelihood of breast cancer screening completion did not differ by social risk status. Conclusion Social risks affect both the ordering and the receipt of cancer screening. Research is needed on strategies to mitigate the impact of different social risks on cancer early-detection services.