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

This cohort study used data from 31,568 women aged 40–74 without prior breast cancer in the All of Us Research Program to examine whether perceived individual and neighborhood factors influence mammography use.

Perceived stress, everyday discrimination, neighborhood physical disorder, neighborhood social cohesion, and mammography receipt were assessed using linked surveys and electronic health records. Overall, 52% of participants had at least one mammogram during follow-up.

Key findings:

• Higher perceived stress was associated with lower breast cancer screening rates (incidence rate ratio [IRR] 0.84; 95% CI, 0.79–0.90).
• Higher levels of perceived everyday discrimination were also associated with reduced screening (IRR 0.92; 95% CI, 0.88–0.95).
• Perceived neighborhood physical disorder and social cohesion were not associated with mammography rates.
• Women reporting high stress and high discrimination were less likely to be compliant with guideline-recommended screening.
• These associations did not differ by race or ethnicity.

The study suggests that women experiencing high stress and discrimination face additional barriers to obtaining mammography, independent of neighborhood context.