UCSF

BACKGROUND: Social risks are negatively associated with receipt of cancer preventive care. As knowledge is lacking on the pathways underlying these associations, we investigated associations between patient-reported social risks and colorectal (CRC), cervical (CVC), and breast cancer (BC) screening order provision and screening completion. METHODS: This study included patients eligible for CRC, CVC, or BC screening at 186 community-based clinics between July 1, 2015 and February 29, 2020. Outcomes included: up-to-date status for indicated cancer screenings at baseline; percent of subsequent study months in which patients were up to date on screenings; screening order receipt; and screening completion. Independent variables were patient-reported food insecurity, transportation barriers, and housing instability. Analyses used covariate-adjusted generalized estimating equation models, stratified by social risk. RESULTS: Patients with documented social risks were less likely to be up-to-date on any cancer screening at baseline and in most cases had a lower rate of total study months up to date on screenings. All cancer screenings were ordered less often for food-insecure patients. CVC screening was ordered less often for transportation-insecure patients. The likelihood of completing a screening test differed significantly by select social risks: CVC and CRC screening rates were lower in food-insecure patients and CRC screening rates were lower in transportation-insecure patients. Likelihood of BC screening completion did not differ by social risk status. DISCUSSION: Social risks affect both the ordering and receipt of cancer screening. Research is needed on strategies to mitigate the impact of different social risks on cancer early detection services.