Predictors of Breast Cancer Screening Variability Among National Breast and Cervical Cancer Early Detection Program Awardees: Provider Shortages and Nurse Practitioner Autonomy

Abstract

Objective:

The percentage of eligible women screened for breast cancer varies among National Breast and Cervical Cancer Early Detection Program (NBCCEDP) awardees. We assessed the effect of awardee- and state-level factors on the percentage of eligible women screened for breast cancer among NBCCEDP awardees. We focused on primary care–health professional shortage areas (PC-HPSAs) and nurse practitioner scope of practice.

Methods:

First, we calculated the study outcome, defined as the percentage of eligible women screened among NBCCEDP state awardees during July 2022–June 2024. Next, we gathered data on awardee- and state-level predictors from multiple sources and estimated 2 general linear multilevel models. Models differed only by the inclusion of an interaction term between PC-HPSA and nurse practitioner autonomy. Finally, we calculated marginal and partial R² to determine combined and individual contributions of predictors on variability in the study outcome.

Results:

The average percentage of eligible women screened for breast cancer among awardees was 9.6% (range, 0.5%-78.0%). Awardees in states with (1) full nurse practitioner autonomy or (2) a larger percentage of their population living in PC-HPSAs screened larger percentages of eligible women as compared with awardees in states without full autonomy or with smaller PC-HPSA populations. Awardees in states with full nurse practitioner autonomy and larger PC-HPSA populations screened even higher percentages of eligible women (β = 0.46; P = .02). Interaction model predictors explained 59% (marginal R² = 0.59) of the variability in the percentage of eligible women screened among awardees, with PC-HPSA being the largest contributor, explaining 27% of the variability (partial R² = 0.27).

Conclusions:

NBCCEDP awardees can encourage their clinical partners to reach women in PC-HPSAs and encourage strategic partnerships with nurse practitioners to address differences in screening.