Effect of comorbid mood and anxiety disorders on breast and cervical cancer screening in immune-mediated inflammatory disease

Abstract

We aimed to examine rates of breast and cervical cancer screening in women with immune-mediated inflammatory diseases (IMID), including inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) versus a matched cohort with IMID; and examine the association of psychiatric comorbidity with screening in these populations. We conducted a retrospective cohort study in Manitoba, Canada using administrative data. We identified women with IBD, MS and RA, and controls without these IMID matched on age and region. Annually, we identified individuals with any active mood/anxiety disorder. Using physician claims, we determined the proportion of each cohort who had cervical cancer screening within three-year intervals, and mammography screening within two-year intervals. We modeled the difference in the proportion of the IMID and matched cohorts who underwent mammography; and pap tests using log-binomial regression with generalized estimating equations, adjusting for sociodemographics, comorbidity and immune therapy use. We tested for additive interactions between cohort and mood/anxiety disorder status. During 2006–2016, we identified 17,230 women with IMID (4,623 with IBD, 3,399 with MS, and 9,458 with RA) and 85,349 matched controls. Having an IMID was associated with lower (-1%) use of mammography; however, this reflected a mixture of more mammography in the IBD cohort (+2.9%) and less mammography in the MS (-4.8 to -5.2%) and RA (-1.5%) cohorts. Within the IBD, MS and RA cohorts, having an active mood/anxiety disorder was associated with more mammography use than having an inactive mood/anxiety disorder. The MS and RA cohorts were less likely to undergo Pap testing than their matched cohorts. In the absence of an active mood/anxiety disorder, the IBD cohort was more likely to undergo Pap testing than its matched cohort; the opposite was true when an active mood/anxiety disorder was present. Among women with an IMID, mood/anxiety disorder influence participation in cancer screening.

Multiple Sclerosis and the Cancer Diagnosis

“…The cancer diagnostic route taken by patients with MS was previously unknown; however, less breast and colorectal cancer screening detection has been observed in other populations with high comorbid disease burden, 7,33 and less cancer screening has been documented in the broader MS population. [8][9][10]34 Patients with MS and severe disability are less likely to have annual mammograms and screening colonoscopies over age 50 years. 34 Similarly, 48% of patients with MS over age 50 years in New York and New Jersey were not having yearly mammograms 8 and patients with MS in Manitoba were 4.8%-5.2% less likely to have regular mammography compared to matched controls.…”

“…34 Similarly, 48% of patients with MS over age 50 years in New York and New Jersey were not having yearly mammograms 8 and patients with MS in Manitoba were 4.8%-5.2% less likely to have regular mammography compared to matched controls. 9 A study from British Columbia, Canada, showed larger tumor size in patients with MS and breast, prostate, colorectal, or lung cancer, with overall differences driven more by lung and colorectal cancer. 35 A Danish study observed larger tumor size in patients with MS and breast cancer vs patients without MS with breast cancer.…”

“…[3][4][5][6][7] Screen detection may be lower in persons with MS and a cancer diagnosis. The existing evidence in the MS population as a whole shows compromised access to cancer screening 8,9 and that women with MS who have mobility impairments are less likely to undergo preventative cancer screening than women with MS without mobility impairments. 10 Localized cancer stage is a measure of early detection and stage is strongly associated with cancer survival.…”

Cancer Screening in Patients With Multiple Sclerosis

“…Nevertheless, the main conclusion suggests that patients with MS and breast cancer have lower rates of obtaining cancer screening services, which is consistent with prior reports that patients with MS in general have lower rates of all cancer screenings. 7,8…”

“…Nevertheless, the main conclusion suggests that patients with MS and breast cancer have lower rates of obtaining cancer screening services, which is consistent with prior reports that patients with MS in general have lower rates of all cancer screenings. 7,8 These are compelling results that require further reflection on barriers to cancer screening in the MS population, but there are limitations to consider, including the cross-sectional study design. The advantage of the Canadian dataset is the government health system record, but these data may not be generalizable to countries with more heterogenous health care provision, such as in the United States.…”