Keegan Grace, Ravenell Joseph, Crown Angelena, DiMaggio Charles, Joseph Kathie-Ann
Surgery, Weill Cornell Medicine, New York, NY, USA.
Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA.
Ann Surg Oncol. 2025 Jul 2. doi: 10.1245/s10434-025-17608-y.
Unmet structural and social needs create barriers to breast cancer screening and treatment. The impact of the intersection of these barriers on screening participation and timeliness of breast cancer care remains poorly understood.
People identifying as women participating in a breast cancer navigation program for screening or treatment were included. Patient navigators administered survey questions that addressed potential barriers to care access using the Health Leads Screening Toolkit. Odds ratios were calculated for unadjusted bivariate associations, and Cox proportional hazards were used to examine the relationship between barriers and time to treatment.
A total of 2804 women (mean age, 53 years) enrolled in navigation for screening or cancer treatment participated in the survey about barriers to care. Of those, 435 (16%) reported unstable housing, 610 (23%) reported poor health literacy, and 164 (6%) reported feeling depressed. Limited transportation was significantly associated with unstable housing (odds ratio [OR] = 26.5, 95% confidence interval [CI] 19.9-35.4, p < 0.00001), poor health literacy (OR = 11.5, 95% CI 9.3-14.2, p < 0.0001), and depression (OR = 2.9, 95% CI 2.1-4.0, p < 0.00001). Individual barriers were not associated with a longer time to treatment, but an increasing number of barriers was associated with a longer time to treatment (Coef = 0.9, p < 0.05).
Compounding structural and social barriers limit participation in breast cancer screening, and women with increasing unmet social needs face delays in treatment for breast cancer. Navigation programs may help women overcome barriers to care; however, understanding and targeting the intersectionality of unmet needs is essential for targeted interventions through breast cancer care navigation programs to be effective.
未满足的结构和社会需求对乳腺癌筛查和治疗造成了障碍。这些障碍的交叉对筛查参与率和乳腺癌治疗及时性的影响仍知之甚少。
纳入参与乳腺癌筛查或治疗导航项目的女性。患者导航员使用健康引导筛查工具包提出调查问题，以解决获得护理的潜在障碍。计算未调整的二元关联的比值比，并使用Cox比例风险模型来检验障碍与治疗时间之间的关系。
共有2804名参与筛查或癌症治疗导航的女性（平均年龄53岁）参与了关于护理障碍的调查。其中，435人（16%）报告住房不稳定，610人（23%）报告健康素养差，164人（6%）报告感到抑郁。交通不便与住房不稳定（比值比[OR]=26.5，95%置信区间[CI]19.9-35.4，p<0.00001）、健康素养差（OR=11.5，95%CI 9.3-14.2，p<0.0001）和抑郁（OR=2.9，95%CI 2.1-4.0，p<0.00001）显著相关。个体障碍与较长的治疗时间无关，但障碍数量增加与较长的治疗时间相关（系数=0.9，p<0.05）。
结构和社会障碍的叠加限制了乳腺癌筛查的参与，社会需求未得到满足的女性面临乳腺癌治疗延迟。导航项目可能有助于女性克服护理障碍；然而，理解并针对未满足需求的交叉性对于通过乳腺癌护理导航项目进行有针对性的干预以取得成效至关重要。
