Evaluating the association between upstream perceived individual and neighborhood determinants of health and intensity of breast cancer screening - Scorecard - MDSpire
Advertisement
Evaluating the association between upstream perceived individual and neighborhood determinants of health and intensity of breast cancer screening
Clinical Scorecard: Assessing the Link Between Perceived Individual and Neighborhood Health Determinants and Mammography Screening Frequency
At a Glance
Category
Detail
Condition
Breast cancer screening via mammography
Key Mechanisms
Impact of perceived individual stress and discrimination, and neighborhood factors on mammography screening rates
Target Population
Women aged 40-74 without history of breast cancer, including non-Hispanic Black, Hispanic, and non-Hispanic White women
Care Setting
Primary care and screening facilities within health systems participating in the All of Us Research Program
Key Highlights
Higher perceived stress and discrimination are associated with lower mammography screening rates.
Perceived neighborhood physical disorder and social cohesion were not significantly associated with screening rates.
Disparities in screening related to stress and discrimination do not differ by race and ethnicity, but Hispanic women have lower overall screening rates.
Guideline-Based Recommendations
Diagnosis
Identify women aged 40-74 for breast cancer screening eligibility.
Assess patient-reported stress and experiences of discrimination as part of social determinants of health screening.
Management
Address barriers related to high stress and discrimination to improve mammography uptake.
Provide culturally sensitive education and support to marginalized groups to enhance screening adherence.
Monitoring & Follow-up
Track mammography screening rates longitudinally, especially in populations reporting high stress and discrimination.
Monitor compliance with breast cancer screening guidelines across racial and ethnic groups.
Risks
High perceived stress and discrimination may lead to reduced screening and delayed breast cancer detection.
Structural and social determinants contribute to inequities in breast cancer outcomes.
Patient & Prescribing Data
31,568 female participants aged 40-74 without breast cancer history from the All of Us Research Program
52% had at least one mammogram during follow-up; higher stress and discrimination correlated with lower screening incidence rate ratios (IRR 0.84 and 0.92 respectively).
Clinical Best Practices
Incorporate assessment of social determinants such as stress and discrimination in routine clinical evaluations.
Implement targeted interventions to reduce barriers to mammography in high-stress and high-discrimination populations.
Recognize that neighborhood physical disorder and social cohesion may have less direct impact on screening rates compared to individual-level stress and discrimination.
Ensure equitable access and follow-up for repeat mammography, particularly among non-Hispanic Black and Hispanic women.
