Guideline-concordant cancer screening among U.S. adults with and without cardiovascular risk factors.

Abstract

e22565 Background: Uptake of age- and sex-appropriate cancer screening remains suboptimal in the United States. Patients with cardiovascular risk factors have increased direct cancer risk through shared behavioral, environmental, and inflammatory pathways. However, these patients may also have more frequent touchpoints with the health care system for management of their CV conditions, raising opportunities for appropriate cancer screening. Thus, we evaluate whether individuals with CV risk factors have higher rates of guideline-concordant cancer screening compared with those without such risks. Methods: We analyzed pooled 2018–2024 data from the National Health Interview Survey, restricting the sample to adults without a prior history of cancer. CV risk was defined by the presence of one or more of the following conditions: coronary heart disease, high cholesterol, congenital heart disease, diabetes, prior myocardial infarction, hypertension, or other heart disease. Outcomes included receipt of age- and sex-appropriate cancer screening (mammography, prostate-specific antigen (PSA) testing, and colonoscopy), determined according to U.S. Preventive Services Task Force recommendations. Covariates included health insurance status, private insurance, and family cancer history. Sample weights were applied to account for complex survey design. Multivariable logistic regressions were estimated for each sample. Results: Unweighted sample sizes were as follow: mammography (9,390), PSA (3,723), and colonoscopy (16,080). Survey-weighted rates of cardiovascular risk factors for each sample of screening-eligible individuals were as follow: mammography (67.8% [SE: 1.72]), PSA (82.5% [1.97]), and colonoscopy (74.8% [1.20]). In multivariable regression models, having CV risk factors was not significantly associated with increased cancer screening: mammography (OR: 1.09, p: 0.25), PSA (OR: 1.49, p: 0.19), and colonoscopy (OR: 1.03, p: 0.73). Conclusions: In this nationally representative study, cardiovascular risk factors were not associated with higher rates of guideline-concordant mammography, PSA testing, or colonoscopy. These findings suggest that chronic cardiovascular care does not consistently facilitate cancer screening, potentially due to competing clinical priorities and fragmented care. However, given continued shared risk factors, integrating cancer screening into cardiovascular disease management may represent an important opportunity to improve preventive care delivery.