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The Impact of Adverse Childhood Experiences on Cancer Screening Adherence: Results from a National Health Behaviors Survey
Klara Pohl, MD.
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
BACKGROUND: Adverse childhood experiences (ACEs), defined as potentially traumatic events occurring before age 18, including physical, sexual, emotional abuse, neglect, and household dysfunction, are associated with increased health risks, including cancer. Previous studies examining associations between ACEs and cancer screening behaviors show inconsistent findings. This study examines associations between ACEs and guideline-recommended breast, prostate, cervical and colorectal cancer screening behaviors using data from 28 U.S. states.
METHODS: We conducted a cross-sectional analysis of 134,174 respondents from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) who completed the ACE module. Adherence to cancer screening guidelines was assessed according to U.S. Preventive Services Task Force recommendations. Multivariable logistic regression was used to analyze associations between ACE exposure (categorized as 0, 1, 2, 3, or ≥4 ACEs) and screening adherence, adjusting for sociodemographic and health care access factors.
RESULTS: The weighted cohort consisted of 43.1 million females (54%) and 37.2 million males (46%), with 63% of females and 62% of males reporting at least one ACE. Women with two ACEs (aOR 0.76, 95% CI: 0.61-0.94) or ≥4 (aOR 0.77, 95% CI: 0.65-0.90) were significantly less likely to adhere to breast cancer screening guidelines. Similarly, men with one (aOR 0.78, 95% CI: 0.66-0.91) or two ACEs (aOR 0.74, 95% CI: 0.59-0.91) had lower prostate cancer screening adherence. No significant associations were found between ACEs and cervical or colorectal cancer screening after adjustment. Insurance coverage and having a personal doctor were the strongest predictors of screening adherence.
CONCLUSIONS: Exposure to ACEs is associated with reduced adherence to breast and prostate cancer screening, potentially compounding cancer risks already faced by individuals with a history of ACEs. These findings highlight the impact of childhood adversity on preventive health behaviors and underscore the need to address healthcare access barriers to improve cancer screening among vulnerable populations.
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