The Impact of Adverse Childhood Experiences on Cancer Screening: Findings From the Behavioral Risk Factor Surveillance System.

Abstract

Adverse childhood experiences are associated with increased health risks, including cancer, but their impact on cancer screening behaviors remains inconsistently documented. This study examines the associations between adverse childhood experiences and guideline-recommended breast, prostate, cervical, and colorectal cancer screening behaviors using data from 28 U.S. states. A cross-sectional analysis of 134,174 respondents from the 2020 Behavioral Risk Factor Surveillance System was conducted, representing 80.1 million adults. Cancer screening adherence was assessed according to U.S. Preventive Services Task Force recommendations. Multivariable logistic regression was used to analyze the associations between adverse childhood experience exposure (0, 1, 2, 3, or ≥4 adverse childhood experiences) and screening adherence, adjusting for sociodemographic and healthcare access factors. Women with 2 adverse childhood experiences (adjusted prevalence ratio=0.95, 95% CI=0.91, 1.00) or ≥4 adverse childhood experiences (adjusted prevalence ratio=0.95, 95% CI=0.92, 0.98) were significantly less likely to adhere to breast cancer screening guidelines. Men with 1 adverse childhood experience (adjusted prevalence ratio=0.88, 95% CI=0.81, 0.96), 2 adverse childhood experiences (adjusted prevalence ratio=0.86, 95% CI=0.77, 0.94), and 3 adverse childhood experiences (adjusted prevalence ratio=0.87, 95% CI=0.78, 0.98) had lower rates of prostate cancer screening adherence. No significant associations were found between adverse childhood experiences and cervical or colorectal cancer screening. Insurance coverage and having a personal doctor were the strongest independent predictors of screening adherence. Exposure to adverse childhood experiences is associated with reduced adherence to breast and prostate cancer screening, potentially compounding cancer risks in individuals with adverse childhood experience exposure. These findings highlight the importance of addressing barriers to cancer screening among individuals with histories of childhood adversity.