OBJECTIVES: Multiple factors can impact cancer screening, which is important in early detection and morality reduction. This study linked social determinants of health data (SDoH) from the Robert Wood Johnson Foundation (RWJF) County Health Rankings to the Merative^TM MarketScan^® Commercial and Medicare Databases to investigate how SDoH may influence screening rates.

METHODS: National Quality Forum cervical cancer (CC) and breast cancer (BC) screening measures were evaluated in the MarketScan Databases in 2020. Patient demographic and SDoH (geographic level linkage) characteristics were compared between women who did or did receive cancer screening.

RESULTS: Approximately 2 million women with SDoH data available were eligible for each screening measure; 68.9% were screened for BC and 67.6% were screened for CC. Among the subset eligible for both measures only 53.0% received both CC and BC screening. Unscreened patients in each sample tended to be older, report poor/fair health, less likely to have completed high school, and live in an area with fewer primary care physicians. In the BC sample screened women tended to report being smokers or obese, had higher rates of sexually transmitted infections (STIs), and shorter life expectancy; economically, BC screened women tended to have a lower median household income and live in areas with reduced income inequality compared to unscreened women. Conversely in the CC sample, unscreened women tended to be smokers, obese, have STIs, and had a shorter life expectancy; there were also trends for CC unscreened women to have a lower median household income and live in areas with lower income inequality.

CONCLUSIONS: Findings from this study demonstrate that trends associated with BC screening do not necessarily hold for CC screening. Improved understanding of the specific social, health, and economic issues influencing the propensity to receive individual cancer screenings could help target preventative health interventions in the United States.