ASPO Abstracts
Psychological Distress and Adherence to Mammogram Screening Recommendations: Results from the 2018 Health Information National Trends Survey
Category: Early Detection & Risk Prediction
Conference Year: 2020
Abstract Body:
Purpose: Although epidemiologic research suggests that psychological distress can serve as a barrier to breast
cancer screening, no current study has examined this relationship under revised guidelines that prioritize
screening in women aged 50-74.
Methods: The 2018 Health Information National Trends Survey, conducted by the National Cancer Institute to
monitor the US population’s use of cancer-related information, provided the data for this analysis. The survey
included demographic, self-reported health, distress, and mammogram screening questions. The Personal Health
Questionnaire-4 (PHQ-4) measured depression and anxiety with 4 items; the total score was dichotomized by
normal/mild (0-5) versus moderate/severe (>=6). Mammogram screening was dichotomized as adherent
(screened within the past 2 years) or non-adherent (screened >2 years ago or never). Women with a history of
breast cancer were excluded. The sample included women aged 50-74 (N=976), with additional sensitivity
analyses for women aged 40-74 (N=1,262). Weighted logistic regression models examined the odds of
mammogram adherence.
Results: The sample consisted of non-Latina white (73%), non-Latina black (15%), and Latina (13%) women who
were predominately college educated (68%). Adherence rates were 81% for women aged 50-74 and 75% for
women aged 40-74, with 13% reporting moderate or severe distress regardless of age range. The unadjusted
model found women with moderate or severe scores on the PHQ-4 had lower odds of adherence to screening
(OR: 0.30, CI: 0.17-0.52). Distress remained an independent predictor of screening when adjusted for age,
race/ethnicity, education, and health status (OR: 0.27, CI: 0.10-0.71); incomes of $0-$19,999 (OR: 0.30, CI: 0.11-
0.80) and $20,000-$74,999 (OR: 0.46, CI: 0.23-0.93) were also associated with lower adherence odds.
Conclusion: These findings corroborate research linking psychological distress with poor preventative health
maintenance. Routine screening for psychological distress might identify women at risk for poor adherence to
breast cancer screening who could benefit from supplemental interventions to help them overcome barriers.
Keywords: pyschological distress, mammogram, screening, breast cancer