Screening Mammogram Utilization in Women With Diabetes

Abstract

OBJECTIVE -To determine whether women with diabetes undergo fewer screening mammograms than matched control subjects.RESEARCH DESIGN AND METHODS -A total of 424 women with diabetes aged 50 -75 years who received their primary care from general internists at a large Midwestern multispecialty group practice were retrospectively studied for frequency of mammography from August 1997 to January 2000. Two control subjects without diabetes (n ϭ 845) were matched to each case by age, sex, provider, and date of visit. The main outcome measure was the percentage of subjects undergoing mammography 1 year before and 30 days after an index date, defined as the most recent health care visit after August 1997 and before January 2000.RESULTS -Analysis by conditional logistic regression demonstrated that women with diabetes had significantly lower rates of mammograms than control subjects (78.1 vs. 84.9%, respectively; odds ratio 0.63, P ϭ 0.002). After adjusting for insurance status and race, women with diabetes continued to have significantly lower rates of mammography (odds ratio 0.70, P ϭ 0.027).CONCLUSIONS -Women with diabetes were significantly less likely to undergo screening mammography than control subjects. Considering the increasing incidence of diabetes and the equal incidence of malignancy in women with and without diabetes, it would be beneficial to improve breast cancer screening in this population.

Prevalence and Trends of Receipt of Cancer Screenings Among US Women with Diagnosed Diabetes

“…Two early and one recent case-control studies showed that the rate of having a mammography screening were significantly lower among women with diabetes than among those without diabetes [21][22][23] ; however, these studies were limited either by small sample sizes or the inclusion of women aged ≥50 years. In addition, a Canadian study of women aged 50−67 years also showed a lower rate of receiving a mammography screening among those with diabetes than those without 24 .…”

Colorectal cancer screening among obese versus non-obese patients in primary care practices

“…Other studies showing comorbidity to be associated with decreased breast and cervical cancer screening did not control for obesity. [27][28][29] From the patient point of view, obese persons may avoid getting CRC screening, particularly colonoscopy and sigmoidoscopy, more than other persons because of embarrassment, concerns about modesty, or fear of pain. In a 1994 study, Olson et al found that obese women commonly delayed or cancelled a physician appointment, including appointments for pelvic exams, because of embarrassment or to avoid being weighed or receiving a lecture about obesity.…”

Diabetes mellitus and breast cancer: a retrospective population-based cohort study

“…First, women with diabetes may have increased screening opportunities due to more frequent physician visits [34], potentially leading to greater breast cancer diagnoses within this population. Second, breast cancer rates tend to be higher among women of higher socioeconomic status (SES) [4], and because diabetes is more prevalent among persons with low SES [35] the association between diabetes and breast cancer may have been underestimated.…”