Выжившие после детского насилия реже проходят скрининг на рак, несмотря на доход и страховку

Adult survivors of childhood abuse are consistently less likely to follow US Preventive Services Task Force (USPSTF) cancer screening guidelines regardless of socioeconomic status or access to health care, according to research published in PLOS Global Public Health. “Screening shortfalls were most consistent for cervical and breast screening across multiple socioeconomic and health care-access strata and were particularly pronounced among breast screening among uninsured adults,” study researchers reported. “These findings underscore the importance of reducing structural barriers and expanding access to preventive care, alongside trauma-informed approaches, to improve cancer screening uptake among populations affected by childhood adversity.” In this analysis, the researchers reviewed data from the Centers for Disease Control and Prevention’s 2020 Behavioral Risk Factor Surveillance System, a nationally representative phone survey of US adults conducted annually. The 123,169 respondents answered questions relating to physical, sexual, or emotional abuse in childhood; 43.7% reported some form of childhood abuse. Women made up 52.3% of the cohort, and 62.7% of respondents identified as White. Just over 12% of respondents reported a history of any cancer, and 16.7% said their health was fair or poor. Individuals with a history of childhood abuse were younger than those who had never experienced abuse (18-34 years: 30.7% vs 24.5%), more likely to have a household income less than $75,000 (57.8% vs 52.9%), and more likely to be uninsured (10.5% vs 7.9%). Abuse survivors also self-reported poorer health (19.7% vs 14.3%), reported cost barriers to care more often (17.4% vs 8.7%), and were less likely to have a personal doctor (73.4% vs 77.0%). Overall, 58,390 respondents were eligible for colorectal cancer (CRC) screening (no abuse: n=33,088; abuse: n =25,302); 27,368 women were eligible for cervical cancer screening (no abuse: n=14,069; abuse: n=13,299); and 39,986 women were eligible for breast cancer screening (no abuse: n=21,922; abuse: n=18,064). Compared with those who did not have a history of abuse, individuals with such history were less likely to adhere to screening guidelines for all 3 cancers: - CRC: 72.4% vs 71.9% - Cervical: 83.9% vs 81.6% - Breast: 73.0% vs 67.0% Childhood abuse remained associated with lower screening adherence in survey-weighted multivariable models: - CRC: adjusted incidence rate ratio (aIRR), 0.97; 95% CI, 0.94-1.00 - Cervical cancer: aIRR, 0.97; 95% CI, 0.94-0.99 - Breast cancer: aIRR, 0.96; 95% CI, 0.93-0.99 Insurance coverage was the strongest predictor for screening adherence across fully adjusted, survey-weighted models. Higher income and a college degree were associated with “modestly higher adherence,” the researchers reported. Patients of color had higher adherence than their White counterparts. The researchers noted that factors typically associated with a protective health effect — education, employment, and marriage — did not mitigate the effects of child abuse. Employment, in fact, appeared to have a negative correlation with adherence. “These findings should be interpreted as associations rather than causal effects, but the findings do highlight potentially modifiable structural and access-related factors that may help identify groups at risk for under-screening and inform future targeted interventions and prospective studies to improve cancer screening uptake among adults with childhood adversity,” the researchers wrote. There was no funding for this study. The study researchers reported having no conflicts of interest. Please see the original reference for complete disclosures. References: Alizai Q, Sarfraz A, Angez M, et al. Past hurts, present hurdles: Analyzing the impact of adult socioeconomic status and healthcare access on cancer screening among childhood abuse survivors. PLOS Glob Public Health. Published online August 26, 2026. doi:10.1371/journal.pgph.0007073