Predictors of Breast Cancer Screening Variability Among National Breast and Cervical Cancer Early Detection Program...

The percentage of eligible women screened for breast cancer varies among National Breast and Cervical Cancer Early Detection Program (NBCCEDP) awardees. We assessed the effect of awardee- and state-level factors on the percentage of eligible women screened for breast cancer among NBCCEDP awardees. We focused on primary care-health professional shortage areas (PC-HPSAs) and nurse practitioner scope of practice.

First, we calculated the study outcome, defined as the percentage of eligible women screened among NBCCEDP state awardees during July 2022-June 2024. Next, we gathered data on awardee- and state-level predictors from multiple sources and estimated 2 general linear multilevel models. Models differed only by the inclusion of an interaction term between PC-HPSA and nurse practitioner autonomy. Finally, we calculated marginal and partial R² to determine combined and individual contributions of predictors on variability in the study outcome.

The average percentage of eligible women screened for breast cancer among awardees was 9.6% (range, 0.5%-78.0%). Awardees in states with (1) full nurse practitioner autonomy or (2) a larger percentage of their population living in PC-HPSAs screened larger percentages of eligible women as compared with awardees in states without full autonomy or with smaller PC-HPSA populations. Awardees in states with full nurse practitioner autonomy and larger PC-HPSA populations screened even higher percentages of eligible women (β = 0.46; P = .02). Interaction model predictors explained 59% (marginal R² = 0.59) of the variability in the percentage of eligible women screened among awardees, with PC-HPSA being the largest contributor, explaining 27% of the variability (partial R² = 0.27).

NBCCEDP awardees can encourage their clinical partners to reach women in PC-HPSAs and encourage strategic partnerships with nurse practitioners to address differences in screening.