Abstract A135: Social disparities in breast cancer screening: Up-to-date screening versus overscreening
Authors: Lui Michelle L. , Lee Argov Erica , Karr Anita G. , Kehm Rebecca D. , Tehranifar Parisa 
Published: September 2024

Abstract
Objective: The United States Preventative Services Task Force breast cancer (BC) screening guidelines in 2022 recommended biennial mammography for women aged 50-74 and cited insufficient evidence to assess mammography’s benefits vs. harms in women aged ≥75. Other guidelines recommend screening cessation for women with &lt;10 years of life expectancy. We examined how racial/ethnic, socioeconomic and geographic patterns observed in up-to-date screening (UTDS) for age-eligible women differ from women aged out of these guidelines or those with limited life expectancy (i.e. overscreening). Methods: We used nationally representative data from the 2022 Behavioral Risk Factor Surveillance System for women aged 50+. Women screened in the past 1-2 years were considered UTDS in age group 50-74 and ‘overscreened’ if 75+ or with a high mortality risk of any age (≥8 score using modified Lee mortality index). We used multivariable logistic regressions to examine UTDS and overscreening in relation to self-identified race/ethnicity, metropolitan status, having a personal health care provider, highest education level, and marital status, stratified by age group and mortality risk. Results: 19.2% of 99601 women aged 50-74 did not have UTDS, while 73.7% of 34545 women 75+ and 60.2% of 22225 women with limited life expectancy continued to receive screening (overscreened). Among those aged 50-74, compared to non-Hispanic (NH) White, NH American Indian/Alaskan Native women (OR=0.60, 95% CI=0.45–0.82) and NH women of unknown race (OR=0.61, 95% CI=0.45–0.82) were less likely to have UTDS while NH Black (OR=1.81, 95% CI=1.60–2.03) and Hispanic (OR=1.24, 95% CI=1.05–1.46) women were more likely to have UTDS. Lower socioeconomic resources were consistently associated with lower likelihood of UTDS (e.g. not having vs. having a personal health care provider (OR=0.22, 95% CI=0.19–0.26) or high school or less education vs. higher than high school (OR=0.73, 95% CI=0.67–0.79)). In ages 75+, compared to NH White, NH Black women were more likely to be overscreened (OR=1.32, 95% CI=1.06–1.65), and NH women of unknown race were less likely to be overscreened (OR=0.49, 95% CI=0.29–0.83). Low socioeconomic indicators were also associated with lower likelihood of overscreening (e.g. not having vs. having a personal health care provider (OR=0.48, 95% CI=0.36–0.63) or high school or less education vs. higher than high school (OR=0.76, 95% CI=0.67–0.86)). Among women with a higher mortality risk, NH Black women (OR=2.05, 95% CI=1.64–2.56) and Hispanic women (OR=1.61, 95% CI=1.09– 2.38) were more likely to be overscreened than NH White women. Conclusion: The findings reveal racial/ethnic, socioeconomic and geographic disparities in UTDS. NH Black and Hispanic women, who are more likely to have UTDS, may be at risk of overscreening as they age or if they have limited life expectancy. These patterns in UTDS and overscreening are critical considerations for implementing equitable BC screening guidelines and optimizing the benefits while minimizing the harms of screening in diverse populations.
Citation Format: Michelle L. Lui, Erica Lee Argov, Anita G. Karr, Rebecca D. Kehm, Parisa Tehranifar. Social disparities in breast cancer screening: Up-to-date screening versus overscreening [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A135.