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Open Access Publications from the University of California

Multilevel Factors in Cancer Screening

  • Author(s): Demb, Joshua Brian
  • Advisor(s): Allen, Isabel E
  • et al.

Cancer is the second leading cause of death in the United States, with cancer of the breast and cancer of the lung and bronchus together accounting for approximately 29% of all cancer cases and 32% of all cancer deaths. Cancer screening tests are a means to reduce mortality of these two cancer types. While the current guidelines aim to maximize the potential benefits from screening while minimizing harms, there is still significant effort needed to achieve optimal breast and lung cancer screening uptake. This dissertation builds upon recent research leveraging multilevel frameworks to examine factors affecting cancer screening use and their importance in clinical practice and in screening guidelines.

The first chapter comprehensively examines the current evidence regarding how various life expectancy factors are associated with screening mammography uptake among women ages 65 and older. The primary objective was to understand the important role life expectancy could play in patient-provider communication regarding whether to continue screening at an advanced age. The second chapter focuses on the variation in performance of lung cancer screening scans, which use low-dose computed tomography. This project sought to identify the potential institutional-level predictors that could lead to radiation doses outside the current guidelines for these scans, potentially impacting the expected margin of benefit from screening. The third and final chapter is a multilevel assessment of the effect of employment status on screening mammography utilization during the Great Recession, to better understand how societal changes can influence individual-level cancer screening behaviors.

Together these projects highlight the interdependence of factors at multiple levels in the cancer screening environment. Examination of these multilevel factors can improve integration of new interventions to optimize cancer screening uptake and ensure that early detection practices are successful, thus improving treatment outcomes and maximizing survival.

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