"Abstract

Background: Despite the proven benefits of early breast cancer detection in reducing mortality, adherence to breast cancer screening guidelines in the United States is suboptimal. In this study, we assessed the prevalence and factors associated with adherence to breast cancer screening guidelines.

Methods: Using nationally representative data from the National Health Interview Survey 2021, we included breast cancer screening-eligible women (aged 50-74). Descriptive statistics and population-weighted multivariable logistic regression were employed to examine breast cancer screening adherence per the United States Preventive Services Task Force guidelines, and its determinants in this population.

Results: Of the 6814 screening-eligible women included in this study, 76.4% adhered to breast cancer screening guidelines. Asians (adjusted odds ratio [AOR]: 0.59 (95% confidence interval [95% CI]: 0.42-0.83), p = 0.003), current cigarette smokers (AOR: 0.62 (95% CI: 0.50-0.76), p < 0.0001), individuals with a precollege educational attainment (less than high school [AOR: 0.60 (95% CI: 0.45-0.80), p = 0.0005] and high school or GED [AOR: 0.79 (95% CI: 0.66-0.94), p < 0.001]), those who reported a poor/fair health status (AOR: 0.71 (95% CI: 0.58-0.86), p = 0.0006), single/widowed/separated/divorced (AOR: 0.71 (95% CI: 0.61-0.82), p < 0.0001), and uninsured (AOR: 0.24 (95% CI: 0.18-0.32), p < 0.0001) women had lower odds of being adherent to breast cancer screening. Non-Hispanic Blacks (AOR: 1.81 (95% CI: 1.38-2.36), p < 0.0001), women who had a routine checkup in the past 2 years (AOR: 11.24 (95% CI: 7.31-17.29), p < 0.0001), and those with a personal cancer history (AOR: 1.44 (95% CI: 1.18-1.76), p = 0.0003) had higher odds of being adherent to breast cancer screening guidelines.

Conclusion: Adherence to breast cancer screening in the United States remained below the Healthy People 2030 goal, with important variations across sociodemographic, behavioral, and health-related factors. Public health actions such as integrating breast cancer awareness activities into smoking cessation programs, encouraging and equipping healthcare professionals to use culturally tailored interventions, and reinforcing community education about breast cancer and its prevention will help increase breast cancer screening adherence among US women."