Breast cancer screening among individuals with a substance use disorder: a retrospective cohort study

There is limited evidence about whether a substance use disorder (SUD) is a barrier to breast cancer screening. Because SUDs are highly prevalent in the USA, it is important to establish whether this patient population is less likely to obtain screening.

This retrospective cohort study included 220 227 patients, with 209 132 having no SUD and 11 095 (5.0%) with SUD based on electronic health record data in a multi-state, Midwestern healthcare system (1 January 2018-31 December 2022). The outcome was the receipt of a mammogram in the 5-year follow-up period. Patients were women aged 40-69 years as of 1 January 2018, with ≥ 2 in-person primary care visits between 2018 and 2022. Covariates included demographics, health services utilization, and physical/psychiatric conditions.

Mean age of the sample was 54.7 (± 8.3) years old. After controlling for confounding, women without any SUDs had more than twice the odds of mammogram receipt compared to those with stimulant use disorder (odds ratio [OR] 2.06; 95% confidence interval [CI]: 1.83-2.33). Women with no SUDs had 89% higher odds of mammogram receipt compared to those with opioid use disorder (OR 1.89; 95% CI: 1.76-2.03), followed by "other" SUDs (OR 1.86; 95% CI: 1.69-2.06), sedative use (OR 1.70; 95% CI: 1.43-2.04), cannabis use (OR 1.58; 95% CI: 1.44-1.74), and alcohol use disorders (OR 1.49; 95% CI: 1.41-1.58).

Despite the high prevalence of SUDs, evidence of preventive service delivery among individuals with SUDs is still lacking. Further research is needed to investigate other healthcare disparities in preventive service delivery among individuals with SUDs.