Breast cancer screening disparities between women with and without disabilities: A national database study in South Korea

Shin, Dong Wook; Yu, Jonghan; Cho, Juhee; Lee, Se Kyung; Jung, Jae-Hun; Han, Kyungdo; Kim, So Young; Yoo, Jung Eun; Yeob, Kyoung Eun; Kim, Yeon Yong; Park, Jong Heon; Park, Jong Hyock; Kawachi, Ichiro

doi:10.1002/cncr.32693

Cited by 32 publications

(25 citation statements)

References 35 publications

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“…21 Other literature suggests that people with ID also participate poorly in screening programs, and this lowers their chances for early detection of cancer types targeted by screening. 20,[39][40][41] For all cancer types in the Dutch screening program (colon, cervical, and female breast), this study showed elevated mortality for people with ID in comparison with the general population. This underlines international concerns about access to and participation in population screening and shows the need to investigate this further.…”

Section: Discussionmentioning

confidence: 67%

Cancer‐related mortality among people with intellectual disabilities: A nationwide population‐based cohort study

Cuypers¹,

Schalk²,

Boonman³

et al. 2021

Cancer

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BACKGROUND:Concerns have been raised about access to cancer screening and the timely receipt of cancer care for people with an intellectual disability (ID). However, knowledge about cancer mortality as a potential consequence of these disparities is still limited. This study, therefore, compared cancer-related mortality patterns between people with and without ID. METHODS: A historical cohort study (2015-2019) linked the Dutch adult population (approximately 12 million people with an ID prevalence of 1.45%) and mortality registries. Cancer-related mortality was identified by the underlying cause of death (according to the chapter on neoplasms in the International Classification of Diseases, Tenth Revision). Observed mortality and calculated age-and sex-standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were reported. RESULTS: There were 11,102 deaths in the ID population (21.7% cancer-related; n = 2408) and 730,405 deaths in the general population (31.2%; n = 228,120) available for analysis. Cancer was noted as the cause of death more often among people with ID in comparison with the general population (SMR, 1.48; 95% CI, 1.42-1.54), particularly in the young age groups. High-mortality cancers included cancers within the national screening program (SMRs,, digestive cancers (SMRs, 1.24-2.56), bladder cancer (SMR, 2.07; 95% CI, 1.61-2.54), and cancers of unknown primary (SMR, 2.48; 95% CI, 2.06-2.89). CONCLUSIONS: Cancer was reported as the cause of death approximately 1.5 times more often in people with ID compared with the general population. This mortality disparity may indicate adverse effects from inequalities in screening and cancer care experienced by people with ID.

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Section: Discussionmentioning

confidence: 67%

Cancer‐related mortality among people with intellectual disabilities: A nationwide population‐based cohort study

Cuypers¹,

Schalk²,

Boonman³

et al. 2021

Cancer

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“…Breast Cancer Screening: Breast cancer is the most frequently diagnosed cancer and the second most common cause of cancer-related death in women. However, with the possibility of early detection through routine screening, the mortality has decreased by 20% with an improved 5-year survival rate ( 32 ). The U.S Preventive Services Task Force (USPSTF) guideline recommends “biennial screening mammography for all women aged 50 to 74 years” including IDW ( 33 ).…”

Section: Resultsmentioning

confidence: 99%

Challenges in Providing Reproductive and Gynecologic Care to Women with Intellectual Disabilities: A Review of Existing Literature

Shrestha¹,

Ishak²,

Maskey³

et al. 2022

JFRH

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Objective: Our review aims to focus on identifying challenges faced by intellectually disabled women (IDW) in receiving gynecological and reproductive care and also highlights evidence based strategies to overcome those challenges. Materials and methods: We conducted a literature review discussing challenges faced by IDW in obtaining healthcare services by thorough search on various electronic databases (PubMed, Google Scholar, and Scopus) starting from 2000 to 28 August 2021 excluding all non-english articles, reviews, editorials and letters to editor. The keywords used for search were “reproductive care”, “gynecologic care”, “intellectual disability”, “mental handicap”, and "mental retardation". Results: The existing literature review showed that IDW have difficulty maintaining menstrual hygiene and lack knowledge regarding contraception use and sexual health resulting in violations of their reproductive rights. Sexually transmitted diseases and cervical cancer are common among IDW due to their vulnerability to sexual abuse. Nulliparity in IDW increases their suspectibility to even breast cancer. Moreover, they face problems with sexually transmitted infection (STI) and cancer screening due to physical barriers for assessment, low socio-economic status, physician-patient communication issues and deficit in skilled providers. Short acting sedatives such as ketamine or midazolam can be used to overcome challenges faced with gynecological and obstetric examination. Finally forced sterilization and institutionalization has been a habitual practice as menstrual hygiene and pregnancy in IDW raise concerns on psychosocial challenges along with associated obstetric complications. Conclusion: Reproductive and sexual health education including contraception use can be provided by using evidence based strategies involving use of pictures, animations and models by adequately trained healthcare providers including midwives. Further research involving IDW is needed to allow state-wise laws and policies to be created to mitigate the challenges and improve health outcomes in this population.

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“…Significant disparities were also found in breast cancer screening, especially in women with severe and mental disabilities. 20 Significant disparities were reported in gastric cancer screening in Korea, especially among people with severe disabilities, renal failure, or mental disabilities. 21 Fujiwara et al 22 reported low rates of cancer screening in schizophrenic patients.…”

Section: Introductionmentioning

confidence: 99%

Disparities in the Diagnosis, Treatment, and Survival Rate of Cervical Cancer among Women with and without Disabilities

et al. 2021

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Introduction Not much is known regarding the disparities in cancer care between women with and without disabilities. Objectives The aim of this study was to investigate the potential disparities in the diagnosis, treatment, and survival of women with cervical cancer with and without disabilities. Methods We performed a retrospective cohort study and linked the National Disability Database, Korean Central Cancer Registry, and Korean National Health Insurance claims database. Charlson comorbidity index was used for adjusting the comorbidity. The study population comprised 3 185 women with disabilities (physical/brain, communication, mental, cardiopulmonary, and other impairment) who were diagnosed with cervical cancer and 13 582 age- and sex-matched women without disability who were diagnosed with cervical cancer for comparison. Results Distant metastatic stage (7.7% vs 3.7%) and unknown stage (16.1% vs 7.0%) were more common in cervical cancer women with grade 1 disabilities, compared with women without disabilities. Women with cervical cancer with disabilities were less likely to undergo surgery (adjusted odds ratio (aOR) 0.81, 95% confidence interval (CI) 0.73–0.90) or chemotherapy (aOR 0.86, 95% CI 0.77–0.97). Lower rate of surgery was more evident in patients with physical/brain impairment (aOR 0.46, 95% CI 0.37–0.58) and severe mental impairment (aOR 0.57, 95% CI 0.41–0.81). The overall mortality risk was also higher in patients with disabilities (adjusted hazard ratio (aHR) 1.36, 95% CI 1.25–1.48). Conclusion Women with cervical cancer with disabilities, especially with severe disabilities, were diagnosed at later stages, received less treatment, and had higher mortality rates, compared with patients who lacked disabilities. Social support and policies, along with education for women with disabilities, their families, and healthcare professionals, are needed to improve these disparities.

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Breast cancer screening disparities between women with and without disabilities: A national database study in South Korea

Cited by 32 publications

References 35 publications

Cancer‐related mortality among people with intellectual disabilities: A nationwide population‐based cohort study

Cancer‐related mortality among people with intellectual disabilities: A nationwide population‐based cohort study

Challenges in Providing Reproductive and Gynecologic Care to Women with Intellectual Disabilities: A Review of Existing Literature

Disparities in the Diagnosis, Treatment, and Survival Rate of Cervical Cancer among Women with and without Disabilities

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