Women with severe, chronic health issues are screened for breast cancer less often

Women with severe disabilities and multiple chronic conditions are screened for breast cancer less often than women with no disabilities or no chronic conditions, a new study has found.

They are also screened less often than women with moderate disabilities or women with only one chronic condition, according to Dr. Sara Guilcher, an affiliate scientist with the Li Ka Shing Knowledge Institute of St. Michael's Hospital.

Dr. Guilcher said women with disabilities often have other measures of social vulnerability, such as low income and low education levels.

Her research, published in the journal Preventive Medicine, is consistent with other studies showing that low income and education were also associated with lower breast cancer screening rates. Previous research has also shown that having a certain level of disability is associated with higher breast cancer screening rates, perhaps because those women have more frequent contact with the health care system.

However, in contrast to previous research, this study identified higher screening rates for women with moderate disabilities compared to those with severe disabilities – who also have greater contact with physicians than other women with no disabilities.

"Despite the presence of a universal health insurance system in Ontario, our research highlights the persistence of significant health disparities in breast cancer screening, particularly for women who are more vulnerable due to severe disability, multiple chronic conditions, low income and lower education," said Dr. Guilcher, who has a PhD in Clinical Epidemiology at the Institute of Health Policy, Management and Evaluation, University of Toronto.

The highest rate of screening was 75 per cent, which was among women with moderate level of disability and one chronic condition. Women with severe disability, across levels of chronic conditions, had the lowest rate of breast cancer screening at 61 per cent. Women with two or more chronic conditions were screened particularly less often.

"Women who are at a lower socioeconomic position may be less likely to be assertive and to be strong advocates for their health care management," said Dr. Guilcher.

Breast Cancer Screening Tests

Breast cancer screening can involve a number of different types of examinations. These include:
Breast Self Examination

During a breast self-examination (BSE), a woman checks her own breasts for any irregularities, which may include lumps, changes in breast size or shape, nipple discharge, or irregular tissue thickening. Despite attempts by investigators to demonstrate the impact of BSE on reducing breast cancer deaths, no study has been able to show a statistically significant reduction. As a result, our doctors and a number of national organizations no longer aggressively encourage women to perform BSE. However, because BSE is easy and free, and may detect some cancers, women are not discouraged from performing regular BSE.