Impact of Multilevel Determinants of Health on Breast Cancer Screening Rates

Screening mammography identifies breast cancer at its earliest, most treatable stage. However, multilevel determinants of health, such as lack of resources, poor mental health, transportation issues, and social isolation, have historically impacted how women access and use screening services. As such, some groups bear a disproportionate burden of advanced breast cancer incidence and mortality.  

In a study published in the American Journal of Epidemiology, Dr. Kevin Kensler, assistant professor of population health sciences, Faith Morley, senior research assistant, and colleagues used data from the National Institutes of Health’s All of Us program to investigate the impact of multilevel determinants of health on breast cancer screening rates. The data accounted for 31,568 female participants aged 40 to 74 without a history of breast cancer. 

According to Dr. Kensler, “The unique elements of the All of Us program data, including a large, diverse group of participants and rich data on multilevel determinants allowed us to apply a novel framework examining how individual level factors, such as stress and discrimination, and contextual factors, including one’s neighborhood social and physical environment, may contribute to disparities in breast cancer screening.” 

“Notably, when examining multilevel determinants of health simultaneously, we observed robust associations between increased perceived stress and discrimination with decreased screening frequency,” said Morley. "Perceived neighborhood determinants had no significant associations with screening.”  

Women reporting high levels of stress and discrimination were also less likely to be compliant with screening guidelines. Individuals with these higher stress levels may be unable to prioritize preventive health care, may lack time or energy, and may face competing priorities. “These findings highlight the importance of targeted interventions that prioritize seeking to ameliorate individual-level barriers related to stress and discrimination to increase screening,” said Morley.