Socio-Economic Determinants of Cancer Screening Adherence Among Cancer Survivors: Analysis from 2020 Behavioral Risk Factor Surveillance System

Background: Factors associated with cancer survivors' preventive health behaviors are understudied. We hypothesized that socioeconomic and healthcare access factors may be associated with adherence to recommended cancer screenings.

Methods: We conducted a cross-sectional analysis using the 2020 Behavioral Risk Factor Surveillance System. Cancer survivors eligible for United States Preventive Services Task Force-recommended breast, cervical, prostate, and colorectal screenings were included. Multivariable logistic regression models were used to identify socioeconomic factors significantly associated with screening adherence.

Results: Overall, 64,958 (Weighted National Estimate 29,066,143) cancer survivors were included. Adherence rates varied across cancer types: 80.9% for breast, 88.9% for cervical, 54.1% for prostate, and 84.7% for colorectal cancer. Key predictors of low adherence included lower income (breast: aOR 0.56; 95%CI 0.43 to 0.74, cervical: aOR 0.38; 95%CI 0.24 to 0.59, prostate: aOR 0.36; 95%CI 0.24 to 0.52, colorectal: aOR 0.74; 95%CI 0.57 to 0.96), lack of healthcare coverage for colorectal cancer (aOR 0.51; 95%CI 0.36 to 0.73), time since last checkup between one and two years prior for breast (aOR 0.58; 95%CI 0.45 to 0.75), prostate (aOR 0.66; 95%CI 0.47 to 0.91), and colorectal (aOR 0.69; 95%CI 0.56 to 0.86) cancer, and no healthcare provider for breast (aOR 0.68; 95%CI 0.47 to 0.98), prostate (aOR 0.45; 95%CI 0.31 to 0.65), and colorectal (aOR 0.51; 95%CI 0.40 to 0.66) cancer.

Conclusion: Cancer survivors' adherence to screening is associated with factors including lack of healthcare coverage, lower income, time since the last exam, and having a personal provider. Targeted interventions accounting for such factors may help mitigate these disparities.