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

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Public health reports (Washington, D.C. : 1974) 2026 p. 333549261421878
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Bermudez Y, Miller J, Kenney K, Schlueter D, Fairley T

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[OBJECTIVE] The percentage of eligible women screened for breast cancer varies among National Breast and Cervical Cancer Early Detection Program (NBCCEDP) awardees.

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APA Bermudez Y, Miller J, et al. (2026). Predictors of Breast Cancer Screening Variability Among National Breast and Cervical Cancer Early Detection Program Awardees: Provider Shortages and Nurse Practitioner Autonomy.. Public health reports (Washington, D.C. : 1974), 333549261421878. https://doi.org/10.1177/00333549261421878
MLA Bermudez Y, et al.. "Predictors of Breast Cancer Screening Variability Among National Breast and Cervical Cancer Early Detection Program Awardees: Provider Shortages and Nurse Practitioner Autonomy.." Public health reports (Washington, D.C. : 1974), 2026, pp. 333549261421878.
PMID 41724668 ↗

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 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;  = .02). Interaction model predictors explained 59% (marginal  = 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  = 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.

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