Evaluating the association between upstream perceived individual and neighborhood determinants of health and intensity of breast cancer screening

Exposure to negative perceived individual and neighborhood determinants disproportionately impacts marginalized groups and can profoundly shape health behavior. We assessed the hypothesized relationship between exposure to adverse perceived individual and neighborhood determinants and rates of mammography. In this cohort study, we identified 31 568 female participants aged 40-74 without history of breast cancer in the All of Us Research Program. Participant-reported levels of perceived stress, everyday discrimination, perceived neighborhood physical disorder, perceived neighborhood social cohesion, and receipt of mammography were ascertained in the linked participant survey and electronic health record data. Fifty-two percent of participants had at least 1 mammogram during follow-up. Women reporting high stress were screened at lower rates compared to low-stress individuals. Higher discrimination (incidence rate ratio [IRR] = 0.92 [95% CI, 0.88-0.95]) and higher perceived stress (IRR = 0.84 [95% CI, 0.79-0.90) were both respectively associated with lower breast cancer screening rates, while perceived neighborhood physical disorder and social cohesion were not. Women reporting high stress and discrimination were also less likely to be compliant with screening guidelines. The associations between the determinants and breast cancer screening rates did not differ by race and ethnicity. Women who report highest levels of discrimination and stress may face additional barriers obtaining breast cancer screening.