ABS 014: Examining the Influence of Accessibility & Social Vulnerabilities on Breast Cancer Screening Uptake

Ananya Uddanti ¹, Erica Lamy ²

¹ Brown University
² Rhode Island Department of Health

The Van Wickle Journal (2026) Volume 2, ABS014

Introduction: Breast cancer remains the most frequently diagnosed cancer among women in the United States (132.9 per 100,000) and shows a higher age-adjusted rate in Rhode Island (RI) (143.2 per 100,000). Screening for breast and cervical cancer is a critical tool for early detection and improving survival outcomes. The Rhode Island Women’s Cancer Screening Program (WCSP), the state’s CDC-funded National Breast and Cervical Cancer Early Detection Program, provides free or low-cost screening to eligible women. Screening for breast and cervical cancer is a critical tool for early detection and improving survival outcomes. This study was conducted to examine spatial, social, and geographic determinants of breast cancer screening across RI.

Methods: A spatial dependence analysis was conducted using Global Moran’s I to test clustering of screening rates and Social Vulnerability Index (SVI) scores, and Local Moran’s I to detect high–high and low–low clusters. To assess associations between social vulnerability and screening, linear regressions were conducted for each of the 16 SVI components. Global Moran’s I for screening rates was 0.143 (z = 4.389, p < 0.001), indicating non-random spatial dependence. Local Indicators of Spatial Association analysis identified high-screening clusters in suburban Zip Code Tabulation Areas and low-screening clusters in several urban areas.

Results: SVI scores were also significantly clustered (Global Moran’s I = 0.223, p < 0.001), demonstrating the spatial concentration of social disadvantage. For transit-reliant populations, accessibility gaps were more pronounced. It was found that poverty (p=0.002), uninsured (p=0.009), housing burden (p=0.008), and disability (p=0.007) were significantly associated with lower screening rates. Adjusted logistic regression analysis showed that Health Equity Zone status was not significantly predictive of screening rates (p = 0.285).

Discussion: This study demonstrates that social vulnerability, rather than geographic proximity, is most consistently associated with lower breast cancer screening rates across RI. It was found that transit accessibility gaps, spatial clustering of vulnerability, and socioeconomic disadvantage collectively contribute to screening disparities. Addressing these factors will be essential for improving preventive care access and advancing health equity statewide.