1. Having a greater number of unmet social needs was associated with lower utilization of screening mammography services, as well as a later stage of breast cancer at the time of diagnosis. 

Evidence Rating Level: 1 (Excellent)

Social determinants of health (SDOH) are important drivers of health inequities. Unmet social needs, such as housing and food insecurity, are known to be associated with worse health outcomes. In this study, researchers aimed to determine whether unmet social needs are associated with the use of screening mammography programs and the stage of breast cancer diagnosis. This prospective cohort study included 322 adult women with stage I-IV invasive ductal or lobular carcinoma. Participants were recruited between 2020 and 2023 from two sites: an underserved safety-net hospital (SNH) and a National Cancer Institute-designated academic cancer center (ACC) in Southern Florida. All participants completed the Health Leads Social Needs Screening Toolkit. Those who presented to the SNH were more likely to be diagnosed with late-stage compared to early-stage disease (15 of 48 [31%] vs 50 of 274 [18%]; P = .04). Having a greater number of unmet social needs was associated with decreased use of screening mammography programs (OR, 0.74; 95% CI, 0.55-0.99; P = .047), as well as a later stage at diagnosis (OR, 0.92; 95% CI, 0.89-0.96; P < .001). Having unmet social needs was still associated with decreased use of mammography even after controlling for access to city-funded mammography programs. A limitation of this study is that participants were only recruited from Southern Florida, and the results may not be generalizable to other populations. Overall, this study demonstrates that greater unmet social needs are associated with lower utilization of screening mammography services, as well as a later stage of breast cancer at the time of diagnosis. Future work may focus on collaboration between healthcare providers, social workers, and policymakers to overcome barriers to screening uptake and facilitate earlier diagnoses for those with unmet social needs.

Click to read the study in JAMA Network Open

Image: PD

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