Cancer survivorship and guideline-concordant screening: Assessment of gaps in colorectal, breast, and cervical cancer screening despite increased healthcare contact (BRFSS 2024).
TL;DR
Survivors were more likely to be up-to-date with CRC and cervical cancer screening but not mammography, and Absolute rates remained below national targets, suggesting increased healthcare contact alone is insufficient.
Abstract
644 Background: Cancer survivors are at elevated risk of subsequent primary cancers and require routine age- and sex-appropriate screening. Prior studies reported higher screening among survivors but were limited to single tests, single states, pre-pandemic data, and few examined sociodemographic factors. We assessed associations between cancer history and colorectal cancer (CRC), breast, and cervical cancer screening adherence, using 2024 BRFSS data. Methods: We conducted a cross-sectional analysis of screening-eligible adults per USPSTF guidelines: CRC (adults 45–75), breast cancer (women 40–74), and cervical cancer (women 21–65). Up-to-date screening was the primary outcome. Survey-weighted multivariable logistic regression estimated adjusted odds ratios (aOR) and predicted prevalences, adjusting for age, sex, race/ethnicity, education, income, insurance, cost barriers, and having a primary provider. Interactions between cancer history and insurance status, cost barriers, and race/ethnicity were tested. Results: Among 457,670 respondents, survivors comprised 31,367 in the CRC, 17,781 in the mammography, and 5,869 in the cervical screening cohort. Unadjusted screening prevalence was higher among survivors across all modalities (CRC 83.6% vs. 68.4%; mammography 78.0% vs. 74.3%; and cervical 82.0% vs. 78.6%; all p < 0.01). After adjustment, survivors remained more likely to be up-to-date with CRC (aOR 1.61; 95% CI, 1.46–1.77; adjusted prevalence 77.4% vs. 69.9%) and cervical screening (aOR 1.47; 95% CI, 1.25–1.73; adjusted prevalence 82.3% vs. 76.6%), but not mammography (aOR 0.93; 95% CI, 0.84–1.04) independent of insurance status and cost barriers. Among survivors, lack of a personal doctor (CRC 64.0% vs. 80.3%; mammography 57.5% vs. 75.8%) and no annual checkup (CRC 67.7% vs. 80.9%; mammography 56.9% vs. 77.5%; cervical 69.8% vs. 84.2%), and uninsurance (CRC 64.2% vs. 79.6%; mammography 61.5% vs. 74.7%) were the strongest predictors of nonadherence. Non-Hispanic Black (aOR 2.69; 95% CI, 1.33–5.44) and Hispanic (aOR 1.95; 95% CI, 1.08–3.50) survivors had higher cervical screening adherence. Adjusted screening rates among survivors remained below Healthy People 2030 targets for all modalities. Conclusions: Survivors were more likely to be up-to-date with CRC and cervical cancer screening but not mammography. Absolute rates remained below national targets, suggesting increased healthcare contact alone is insufficient. Survivorship care should strengthen screening reminders and primary care linkage to close persistent gaps.