Subjective cognitive decline and mammograms: an examination of the Behavioral Risk Factor Surveillance System.

Abstract

Context: Breast cancer is the second leading cause of cancer death among women in the United States. Screening mammograms reduce mortality overall, but they present unique challenges in patients with cognitive impairments. Harms such as psychological distress and financial burden may outweigh benefits provided by screening mammograms. Those with subjective cognitive decline (SCD), defined as self-perceived cognitive decline without measurable cognitive impairment, are a population lacking clear recommendations, and SCD remains understudied regarding mammogram utilization.

Objectives: The objective of this study was to investigate the relationship between SCD and adherence to mammogram screening recommendations.

Methods: To examine the relationship between SCD and mammogram utilization, we conducted a cross-sectional analysis utilizing the 2022 Behavioral Risk Factor Surveillance System (BRFSS) data set. Sociodemographic factors associated with screening rates within the SCD population were assessed. Logistic regression models were utilized to evaluate associations between mammogram screenings within the past 2 years, income levels, and other sociodemographic variables.

Results: A total of 18,344 of the 22,442 (81.2 %) women aged 50-74 in the BRFSS reported having a mammogram in the past 2 years. A total of 1,360 (6.75 %) respondents reported a level of SCD that only affects memory, whereas 1,230 (5.38 %) reported having SCD that impacts memory and ADLs. Although mammogram screening rates decreased in individuals reporting SCD, the rate of decline was only statistically significant if ADLs were affected (AOR: 0.63, 95 % CI: 0.46-0.86; p=0.004). Furthermore, all groups' odds are significantly increased when income is >$50,000, except those in which ADLs are affected by SCD.

Conclusions: Our data indicate similar mammogram screening rates between women with and without SCD as long as ADLs are not affected; however, once SCD impacts ADLs, screening rates for women drop significantly. Interestingly, we found that the women with the highest rates of screening are those with income greater than $50,000 with SCD but no impacts to ADLs and that screening disparities between rural and urban were nonsignificant. Given these contextual differences, additional screening guidelines for mammograms among women with SCD are warranted.