Early detection of cancer can increase the likelihood of survival through the removal of precancerous lesions and/or treatment. Based on this, the American Cancer Society (ACS) and the US Preventive Services Task Force (USPSTF) advocate and endorse routine colorectal (CRC), breast, and cervical cancer screenings. Although US healthcare organizations and healthcare professionals have recommended evidence-based screening guidelines, utilization of cancer screening tests are lower than the US national goals. Specific demographic groups are less likely to receive cancer screening tests, they include groups based on race/ethnicity, socioeconomic status, and healthcare access. These factors that lead to disparities in cancer screenings are known as social determinants of health (SDOH). Social determinants of health consist of factors from multiple levels of influence on health behaviors, including intrapersonal, institutional, and societal. Programs and health insurance coverage reforms exist that may provide free or low-cost cancer screenings tests to people who are un- or under-insured; however, these resources to reduce barriers to cancer screening may not mitigate other financial burdens and competing needs that influence cancer screening utilization. An example is food insecurity; it is a barrier to health and health care access. Over 35 million Americans experience food insecurity, which is defined by a lack of access to adequate food for an active, healthy life. Studies haven’t examined the degree in which food insecurity is associated to cancer prevention behaviors (screening adherence). Studies have linked food insecurity with elevated risk of cancer and other chronic diseases. The Office of Community Outreach and Engagement (OCOE) of the Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium assessed the relationship between food insecurity and cancer screening, in addition to commonly assessed SDOH measures. Addressing this knowledge gap may increase the understanding of disparities that contribute to cancer screening and better inform researchers and intervention groups on how to eliminate cancer disparities. This paper was published in Cancer Epidemiology, Biomarkers, & Prevention.
The OCOE collaborated with colleagues from nine National Cancer Institute (NCI) designated cancer centers who conducted similar assessments of their catchment areas’ population and cancer risk/behaviors; the main variables included food insecurity, other measures of SDOH, and being “up to date” with CRC and breast cancer screening guidelines. The Hunger Vital Signs two-item questionnaire assessed food insecurity; other validated questionnaires were used to assess a broad range of sociodemographic and behavioral factors. The participants included in the CRC screening group were between the ages of 50 and 75 years old and did not report a previous diagnosis of CRC. The final analytic sample for CRC consisted of 4,816 participants across the nine sites. Participants included in the breast cancer screening group were between the ages of 50 and 74 years old and did not report a previous diagnosis of breast cancer. The final analytic sample for breast cancer consisted of 2,449 participants across the nine sites. Weight logistic regression models were used to examine the relationships between food insecurity, other SDOH variables, and cancer screenings.
Elaborating on their paper’s findings Dr. Mendoza said, “across the catchment areas of nine NCI-designated cancer centers, the prevalence of food insecurity was relatively common among those eligible for colorectal cancer screening (18.2%) and breast cancer screening (21.6%); these rates are much higher than national rates of food insecurity collected by the US Department of Agriculture in 2019 (10.5%). Moreover, food insecurity was associated with lower odds of being up to date for colorectal cancer screening (30% lower) and breast cancer screening (40% lower), regardless of race/ethnicity, rurality, marital status, education, income, financial security, health insurance, and history of cancer.”
Dr. Mendoza concluded by saying, “the novel finding is that addressing food insecurity, a common social determinant of health, may improve the effectiveness of programs that promote cancer screenings. Future research should pair food insecurity screening and amelioration with cancer screening programs to examine if efficacy is improved. Besides future research, this study suggests that cancer centers should screen for social determinants of health such as food insecurity, so that these determinants may be addressed to optimize cancer prevention, screening, treatment, and survivorship. Thankfully, the Consortium institutions are systematically implementing these types of screenings for social determinants of health.”
Last, the OCOE thanked the Cancer Consortium Collaboration for their support. First, their funding originated from a supplement to the P30 cancer center support grant. Second, the research was conducted by the Consortium’s Office of Community Outreach and Engagement, which provided key personnel and infrastructure to implement this research project led by Katherine J. Briant, MPH, assistant director of OCOE and a co-author on this paper.
Fred Hutch/University of Washington/Seattle Children's Cancer Consortium member Jason A. Mendoza led this work.
Mendoza JA, Miller CA, Martin KJ, Resnicow K, Iachan R, Faseru B, McDaniels-Davidson C, Deng Y, Martinez ME, Demark-Wahnefried W, Leader AE. Examining the Association of Food Insecurity and Being Up-to-Date for Breast and Colorectal Cancer Screenings. Cancer Epidemiology, Biomarkers & Prevention. 2022 May 4;31(5):1017-25. doi: 10.1158/1055-9965.EPI-21-1116