Cervical and breast cancer screening participation for women with chronic conditions in France: results from a national health survey

Abstract

BackgroundComorbidity at the time of diagnosis is an independent prognostic factor for survival among women suffering from cervical or breast cancer. Although cancer screening practices have proven their efficacy for mortality reduction, little is known about adherence to screening recommendations for women suffering from chronic conditions. We investigated the association between eleven chronic conditions and adherence to cervical and breast cancer screening recommendations in France.MethodUsing data from a cross-sectional national health survey conducted in 2008, we analyzed screening participation taking into account self-reported: inflammatory systemic disease, cancer, cardiovascular disease, chronic respiratory disease, depression, diabetes, dyslipidemia, hypertension, obesity, osteoarthritis and thyroid disorders. We first computed age-standardized screening rates among women who reported each condition. We then estimated the effect of having reported each condition on adherence to screening recommendations in logistic regression models, with adjustment for sociodemographic characteristics, socioeconomic position, health behaviours, healthcare access and healthcare use. Finally, we investigated the association between chronic conditions and opportunistic versus organized breast cancer screening using multinomial logistic regression.ResultsThe analyses were conducted among 4226 women for cervical cancer screening and 2056 women for breast cancer screening. Most conditions studied were not associated with screening participation. Adherence to cervical cancer screening recommendations was higher for cancer survivors (OR = 1.73 [0.98–3.05]) and lower for obese women (OR = 0.73 [0.57–0.93]), when accounting for our complete range of screening determinants. Women reporting chronic respiratory disease or diabetes participated less in cervical cancer screening, except when adjusting for socioeconomic characteristics. Adherence to breast cancer screening recommendations was lower for obese women and women reporting diabetes, even after accounting for our complete range of screening determinants (OR = 0.71 [0.52–0.96] and OR = 0.55 [0.36–0.83] respectively). The lower breast cancer screening participation for obese women was more pronounced for opportunistic than for organized screening.ConclusionWe identified conditions associated with participation in cervical and breast cancer screening, even when accounting for major determinants of cancer screening. Obese women participated less in cervical cancer screening. Obese women and women with diabetes participated less in mammographic screening and organized breast cancer screening seemed to insufficiently address barriers to participation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2295-0) contains supplementary material, which is available to authorized users.

Contextual determinants of participation in cervical cancer screening in France, 2010

“…Self-reported data on cancer screening participation are thought to overestimate actual participation in cervical cancer screening, but the accuracy of self-reporting does not seem to be associated with socioeconomic factors (22). The cervical cancer screening rates observed in our study are similar to those found in the other population surveys in France (23).…”

Modifiable risk factors for advanced vs. early breast cancer in the French E3N cohort

“…They have also been found at increased risk of advanced breast cancer, but in a study that did not adjust for all potential confounders such as the socioeconomic level . Indeed, women with low socioeconomic level are more likely to be obese and to have delayed diagnosis and care . However, our study involved mostly educated women with a reduced range of socioeconomic statuses, and we adjusted our analyses for education.…”

Non-communicable chronic diseases and timely breast cancer screening among women of the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study

“…In addition to the influence of social determinants of health, research findings suggest that chronic diseases also influence the likelihood of timely cancer screening, however the results are equivocal as to whether having a chronic disease facilitates or hinders timely screening. [9–11]. Some studies demonstrate that individuals with existing co-morbidities, such as diabetes, have lower cancer screening rates than those without co-morbidities[12–14]; and in some cases, those with diabetes have lower screening rates despite having more visits to healthcare providers [9, 15–17].…”

“…[9–11]. Some studies demonstrate that individuals with existing co-morbidities, such as diabetes, have lower cancer screening rates than those without co-morbidities[12–14]; and in some cases, those with diabetes have lower screening rates despite having more visits to healthcare providers [9, 15–17]. A proposed reason for this under-screening includes competing priorities, i.e.…”

“…more focus on controlling the chronic disease rather than on cancer screening during office visits [16, 18, 19]. Other studies have found no association between having a chronic disease and timely breast cancer screening [9, 11, 20]. However, a few studies have demonstrated that those with chronic disease are more likely to have screening mammography than those without [21–23].…”