Abstract 5933: Mining multiple national resources to predict adverse effect of poor screening mammography rates and to identify determinants of poor adherence to screening
Authors: Dharamdasani Tina , Satagopan Jaya M. 
Published: June 2022

Abstract
Background: Breast cancer screening plays an integral role in achieving health equity. We apply an inexpensive and scalable data fusion strategy to predict the adverse effect of poor screening mammography rates and to identify the determinants of poor adherence to screening by combining multiple large national databases.
Methods: Using 2008-2010 screening mammography rates in 3,110 U.S. counties from the National Cancer Institute State Cancer Profiles, we created tertiles of counties having poor, medium, and superior screening rates. Using the 2000-2016 Surveillance, Epidemiology, and End Results (SEER) 18 registries covering 612 U.S. counties, we abstracted a listing of breast cancer cases of multiple race/ethnicities, female sex, and diagnosed at age 40 years or above. We linked these data to assign screening rate category to each breast cancer case. We used breast cancer stage categorized as regional/distant and localized as the outcome to examine the adverse effect of poor screening. Using the National Health Interview Survey (NHIS) between 2000 and 2015, we obtained data on adherence to screening (i.e., having mammogram within 2 years) and factors corresponding to the Anderson Model for Healthcare Utilization from survey participants of multiple race/ethnicities, female sex, and age 40 years or above. We applied race/ethnicity-stratified logistic regression models to estimate the risk of regional/distant relative to localized stage breast cancer in relation to screening categories, adjusting for age and tumor characteristics, and to identify factors associated with adherence to screening.
Results: Among 645,755 breast cancer cases in SEER (72% Non-Hispanic (NH) White, mean [SD] age of 62 [12] years), 36% had regional/distant stage disease. Poor screening rate was associated with increased risk of regional/distant stage for NH White (OR=1.06, 95% CI: 1.05, 1.08), Hispanic (OR=1.12, 95% CI: 1.07, 1.16), and South Asian cases (OR=1.26, 95% CI: 1.08, 1.48). Among 68,519 women in NHIS (73% non-Hispanic [NH] White, mean [SD] age of 53 [18] years), higher education (OR= 1.55, 95% CI: 1.43, 1.68) and insurance coverage (OR= 2.21, 95% CI: 1.97, 2.49) increased adherence to screening in NH Whites. Similar results were found in NH Black and Hispanic women. Living in the U.S. for at least 10 years was a key determinant of adherence in South Asian women (OR= 3.57, 95% CI: 1.66, 7.68). Being overweight or obese was a key deterrent to adherence in Chinese women (OR=0.36, 95% CI: 0.23, 0.56).
Conclusion: Mining large databases identified the effect of screening on breast cancer stage and unique factors for adherence to screening in distinct racial/ethnic groups. Further studies of determinants of screening and their associations with breast cancer characteristics may provide targets for breast cancer prevention policies to achieve health equity.
Citation Format: Tina Dharamdasani, Jaya M. Satagopan. Mining multiple national resources to predict adverse effect of poor screening mammography rates and to identify determinants of poor adherence to screening [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5933.