Abstract PS5-12-12: Internet use, access to care, and breast cancer screening among publicly insured women

Abstract Introduction: Biennial screening of breast cancer is crucial for early cancer detection. Although both Medicare and Medicaid provide coverage for breast cancer screening, screening rates among Medicaid recipients have been consistently lower. Internet use to seek out health information has been linked to increased health literacy and preventive care but findings are inconsistent. Internet use may represent a pathway to improve breast cancer screening rates, although little is known about its role among publicly insured women. Methods: This cross-sectional study used data from the 2023 National Health Interview Survey (NHIS), a nationally representative household survey of the non-institutionalized U.S population. Women within the recommended breast cancer screening age, 40-74 years old, were included in the study population. Women in this study population had either Medicaid, Medicare, or Medicare + Supplemental insurance coverage. Women with a history of breast cancer or without valid screening information were excluded from the study. The primary outcome was up to date screenings, defined as receiving either a mammogram or a breast MRI within the past two years. Primary exposures included internet access at home and using the internet to seek health information. Base model covariates were age, education level, and income level; healthcare access variables (having a usual place of care, time since last doctor visit, and time since last wellness visit) were included in a second model. Analyses were conducted in Stata 18. Survey-weighted logistic regression models were estimated using NHIS weights, strata, and primary sampling units to account for the survey design and produce results generalizable to the U.S. population. Results: In the base model, internet use to seek health information was positively but not significantly associated with being up-to-date on breast cancer screening (p = 0.14) while home internet access was not significantly associated (p = 0.77). Compared to Medicare coverage, Medicaid recipients had significantly lower odds of being up-to-date with breast cancer screenings (p = 0.005); Medicare + Supplemental coverage was not significantly different (p = 0.82). Higher education (bachelor’s and above) was associated with increased odds of screening (p = 0.02). Age and income were not significantly associated with being up-to-date. When healthcare access variables were added to the model, internet use to seek health information and home internet access remained nonsignificant (p = 0.22 and 0.27, respectively) and Medicaid coverage was no longer associated with decreased screening odds (p = 0.48). However, access to care variables were strong predictors of breast cancer screening. Having a usual place for care (p = 0.003), a doctor visit within the past year (p = 0.002), and a wellness visit within the past year (p < 0.001) were all significantly associated with being up-to-date on breast cancer screenings. Conclusion: Home internet access and the use of the internet to seek health information were not significantly associated with being up to date on breast cancer screenings among publicly insured women. Instead, differences in screening were strongly explained by healthcare access factors. While Medicaid recipients initially had lower odds of screening compared to Medicare recipients, this association was no longer significant after accounting for access to care. Having a usual source of care, a recent doctor visit, and a recent wellness visit were the strongest predictors of being up-to-date. Given these results, interventions to improve breast cancer screening among publicly insured women may be more effective when focused on improving sources of usual care and access to annual care visits for publicly insured women. Citation Format: H. J. Mohammad, M. T. Halpern, . Internet use, access to care, and breast cancer screening among publicly insured women [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-12-12.