Impact of Perceived Stress and Discrimination on Mammography Screening Rates

Overview

This cohort study of 31,568 women aged 40-74 found that higher perceived stress and everyday discrimination were significantly associated with lower rates of mammography screening. Neighborhood factors such as physical disorder and social cohesion did not show a significant impact on screening frequency. These findings highlight psychosocial barriers that may reduce breast cancer screening adherence across racial and ethnic groups.

Background

Mammography screening has substantially reduced breast cancer mortality by enabling early detection. However, disparities in breast cancer outcomes persist, particularly among non-Hispanic Black and Hispanic women, who face higher mortality and advanced disease at diagnosis. Structural inequities and social determinants, including stress, discrimination, and neighborhood environment, influence health behaviors such as screening utilization. Understanding how these factors collectively affect mammography rates is critical to addressing screening disparities.

Data Highlights

Key Findings

• 52% of women aged 40-74 had at least one mammogram during follow-up.
• Women reporting high perceived stress had significantly lower mammography screening rates (IRR=0.84).
• Higher levels of everyday discrimination were associated with reduced screening rates (IRR=0.92).
• Perceived neighborhood physical disorder and social cohesion showed no significant association with screening frequency.
• The negative associations between stress, discrimination, and screening did not differ by race or ethnicity.
• Women experiencing high stress and discrimination were less likely to comply with breast cancer screening guidelines.

Clinical Implications

Clinicians should recognize that psychosocial stressors and experiences of discrimination may serve as barriers to breast cancer screening across diverse populations. Screening programs and interventions should incorporate strategies to address these individual-level determinants to improve adherence. Efforts to reduce stress and mitigate discrimination could enhance screening uptake and ultimately reduce breast cancer disparities.

Conclusion

Perceived individual-level stress and discrimination are important determinants negatively impacting mammography screening rates, independent of neighborhood factors and race/ethnicity. Addressing these psychosocial barriers is essential to improving breast cancer screening utilization and equity.

References

1. All of Us Research Program -- Cohort Study on Social Determinants and Mammography Screening