A new study supported by a research grant from the Ontario Ministry of Health and Long Term Care (MOHLTC) and published first in the July 27, 2014 online edition of the journal Preventive Medicine suggest that women with severe disabilities and multiple chronic conditions are screened for breast cancer less often than women with no disabilities or no chronic conditions.
According to the Sara Guilcher MD, an affiliate scientist with the Li Ka Shing Knowledge Institute of St. Michael’s Hospital(an affiliated with the University of Toronto), the lead author of the study, these women are also screened less often than women with moderate disabilities or women with only one chronic condition.
…despite the presence of a universal health insurance system… our research highlights the persistence of significant health disparities in breast cancer screening…
Low income and low education
Guilcher said women with disabilities often have other measures of social vulnerability, such as low income and low education levels.
The authors showed that this research 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.
Universal Health Insurance
“Despite the presence of a universal health insurance system in Ontario, Canada, 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,” explained Guilcher, who has a PhD in Clinical Epidemiology at the Institute of Health Policy, Management and Evaluation, University of Toronto.
Screened… less often
The highest rate of screening was 75%, 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%. 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,” Guilcher noted.
Future research
In Ontario, women can refer themselves to the Ontario Breast Screening Program, which sends them reminders of when they are due for mammograms and can provide results at the same time the test is done. Further research could explore the demographics of the women who enrol in this program.
Guilcher said that worldwide, breast cancer is the most prevalent cancer among women and the second leading cause of cancer-related deaths. Deaths have significantly dropped due to advances in prevention and treatment. In Ontario, mortality rates fell 37% for women between the ages of 50 and 74 between 1990 and 2009.
Study design
Her study was done in conjunction with the Institute for Clinical Evaluative StudiesorICES, based on health records of 10,363 women in Ontario ages 50-69 whose health records are stored in databases at ICES.
The researchers used a retrospective population-based cohort study design in which they linked administrative and self-reported survey data to identify screening in Ontario. The cohort was identified using two waves of the Canadian Community Health Survey (2005 and 2007/08). Mammography imaging was identified based on fee codes. Furthermore, rates of mammography screening were examined over a two-year period and compared across level of disability and multi-morbidity.
Results from multivariate regression showed that women with moderate disability had higher odds of being screened compared to women with no disability (OR 1.2 [1.09-1.38]). The results also showed that patients with severe disability had lower odds of being screened compared to patients with moderate disability (OR 0.72 [0.63-0.82]) and no disability (OR 0.88 [0.78-0.99]). Finally, Guilcher and her team showed that women with one chronic condition had higher odds of screening compared to women with no chronic conditions (OR 1.31 [1.17-1.46]).
For more information:
[1] Guilcher SJ, Lofters A, Glazier RH, Jaglal SB, Voth J, Bayoumi AM. Level of disability, multi-morbidity and breast cancer screening: Does severity matter? Prev Med. 2014 Jul 27;67C:193-198. doi: 10.1016/j.ypmed.2014.07.025.[Article][PubMed]
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