Women with diabetes less likely to undergo mammogram screening

Women with diabetes, already at higher risk for breast cancer, are 14% less likely to undergo routine mammogram screening regardless of their socioeconomic status, according to findings published in Diabetic Medicine,

“Our study found having diabetes posed a significant barrier to breast cancer screening even after considering a woman’s socioeconomic status, a known contributor to disparities in care among women,” Lorraine Lipscombe, MD, of Women’s College Hospital, said in a press release.

In a population-based study at the Institute for Clinical Evaluative Sciences and Women’s College Hospital in Canada, researchers examined the influence of diabetes and lower socioeconomic status on mammography rates in 504,288 women aged 50 to 69 years (188,759 with diabetes; 315,529 without diabetes).

Investigators analyzed the likelihood of at least one screening in women with diabetes within a 36-month period, starting Jan. 1, 1999, their 50th birthday or 2 years after diabetes diagnosis — whichever came last. Outcomes were compared with age-matched women without diabetes in the same period, adjusting for socioeconomic status based on neighborhood income and other demographic and clinical variables.

A total of 321,564 (63.8%) women had a mammography screening. Women with diabetes were significantly less likely to have a mammogram after adjusting for socioeconomic status and other factors (OR=0.79; 95% CI, 0.78-0.8). Diabetes was associated with lower mammography rates, even in women from the highest socioeconomic status quintile (OR=0.79; 95% CI, 0.75-0.83).

“Managing the demands of a chronic condition such as diabetes is challenging for many women, leaving other preventive actions, like screening for cancer, to fall by the wayside,” Lipscombe said.

Secondary findings showed 61.1% of women who had a mammography were screened through physician referrals (Ontario Health Insurance Plan database) and 38.9% were screened through the Ontario Breast Cancer Screening Program. The rate of mammograms remained significantly lower for women with diabetes regardless of the service used (diabetes vs. no diabetes: 36.3% vs. 40.6% for Ontario Health Insurance Plan database, P<.001; and 24% vs. 25.3% for Ontario Breast Cancer Screening Program database, P<.001).

“Programs that offer incentives and reminders for cancer screening or allow for self-referral may help to ensure all women are getting their mammograms when they need them most,” Lipscombe said.

Disclosure: Please see the study for full list of disclosures.

Perspective
Leann Olansky, MD

Leann Olansky

  • When a woman has diabetes or other chronic disease that she is forced to think about every day, she thinks less about preventive tests to protect her from the common diseases that every woman is at risk for. This is a shame because many women with diabetes are obese and there is strong evidence that this increases the risk for developing breast cancer.

    • Leann Olansky, MD
    • Endocrinology, Diabetes and Metabolism at Cleveland Clinic
  • Disclosures: Olansky reports no relevant financial disclosures.