In the Journals

Women with diabetes forgo breast, cervical, colorectal cancer screenings

Women with diabetes have suboptimal breast, cervical and colorectal cancer screening rates compared with women without diabetes, although the absolute differences might be modest, according to findings from a meta-analysis of 37 studies published in Diabetologia.

Lorraine Lipscombe

“Women with diabetes are less likely to get recommended cancer screening tests, and this may be because the high health care burden of diabetes distracts patients and their providers from primary preventive care, such as cancer screenings,” Lorraine Lipscombe, MDCM, MSc, FRCPC, associate professor and division director of endocrinology and metabolism at Women’s College Hospital at the University of Toronto, told Endocrine Today. “Women with diabetes are at higher risk of presenting with later-stage cancers, which carry a poorer prognosis and higher mortality.”

Lipscombe and colleagues analyzed data from 37 studies (25 cross-sectional; 12 cohort studies) conducted between 1997 and 2018 with unselected populations that included diabetes status as a predictor of cancer vs. a comparison group without diabetes and cancer screening uptake as an outcome, with 27 studies assessing breast cancer (using mammography), 19 studies assessing cervical cancer (using Pap smear) and 18 studies assessing colorectal cancer (using fecal and endoscopic tests). Cohort sizes ranged from 129 to 732,687. Researchers used random-effects meta-analyses using the most-adjusted estimates for each cancer site.

Across studies, mean sample diabetes prevalence was 15.1% for breast cancer, 9.7% for cervical cancer and 12.4% for colorectal cancer.

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Women with diabetes have suboptimal breast, cervical and colorectal cancer screening rates compared with women without diabetes, although the absolute differences might be modest.

Researchers found that diabetes status was associated with a lower likelihood of breast (adjusted OR = 0.83; 95% CI, 0.77-0.9) and cervical (OR = 0.76; 95% CI, 0.71-0.81) cancer screening relative to not having diabetes. Colorectal cancer screening was comparable across groups with and without diabetes (OR = 0.95; 95% CI, 0.86-1.06); however, women with diabetes were less likely to receive a colorectal cancer screening test than women without diabetes (OR = 0.86; 95% CI, 0.77-0.97).

The researchers noted that, given the increased risk for cancer among women with diabetes, higher quality prospective evidence is needed to evaluate the contribution of diabetes to cancer screening disparities in relation to other patient-, provider- and system-level factors.

“We need to study effective interventions to improve adherence to cancer screening guidelines in patients with diabetes and other chronic conditions, such as regular screening invitations and shared care between specialists and primary care physicians,” Lipscombe said. – by Regina Schaffer

For more information:

Lorraine Lipscombe, MDCM, MSc, FRCPC, can be reached at Women’s College Hospital, University of Toronto, 76 Grenville St., Toronto, ON M5S 1B2, Canada; email: lorraine.lipscombe@wchospital.ca.

Disclosures: The authors report no relevant financial disclosures.

Women with diabetes have suboptimal breast, cervical and colorectal cancer screening rates compared with women without diabetes, although the absolute differences might be modest, according to findings from a meta-analysis of 37 studies published in Diabetologia.

Lorraine Lipscombe

“Women with diabetes are less likely to get recommended cancer screening tests, and this may be because the high health care burden of diabetes distracts patients and their providers from primary preventive care, such as cancer screenings,” Lorraine Lipscombe, MDCM, MSc, FRCPC, associate professor and division director of endocrinology and metabolism at Women’s College Hospital at the University of Toronto, told Endocrine Today. “Women with diabetes are at higher risk of presenting with later-stage cancers, which carry a poorer prognosis and higher mortality.”

Lipscombe and colleagues analyzed data from 37 studies (25 cross-sectional; 12 cohort studies) conducted between 1997 and 2018 with unselected populations that included diabetes status as a predictor of cancer vs. a comparison group without diabetes and cancer screening uptake as an outcome, with 27 studies assessing breast cancer (using mammography), 19 studies assessing cervical cancer (using Pap smear) and 18 studies assessing colorectal cancer (using fecal and endoscopic tests). Cohort sizes ranged from 129 to 732,687. Researchers used random-effects meta-analyses using the most-adjusted estimates for each cancer site.

Across studies, mean sample diabetes prevalence was 15.1% for breast cancer, 9.7% for cervical cancer and 12.4% for colorectal cancer.

#
Women with diabetes have suboptimal breast, cervical and colorectal cancer screening rates compared with women without diabetes, although the absolute differences might be modest.

Researchers found that diabetes status was associated with a lower likelihood of breast (adjusted OR = 0.83; 95% CI, 0.77-0.9) and cervical (OR = 0.76; 95% CI, 0.71-0.81) cancer screening relative to not having diabetes. Colorectal cancer screening was comparable across groups with and without diabetes (OR = 0.95; 95% CI, 0.86-1.06); however, women with diabetes were less likely to receive a colorectal cancer screening test than women without diabetes (OR = 0.86; 95% CI, 0.77-0.97).

The researchers noted that, given the increased risk for cancer among women with diabetes, higher quality prospective evidence is needed to evaluate the contribution of diabetes to cancer screening disparities in relation to other patient-, provider- and system-level factors.

“We need to study effective interventions to improve adherence to cancer screening guidelines in patients with diabetes and other chronic conditions, such as regular screening invitations and shared care between specialists and primary care physicians,” Lipscombe said. – by Regina Schaffer

For more information:

Lorraine Lipscombe, MDCM, MSc, FRCPC, can be reached at Women’s College Hospital, University of Toronto, 76 Grenville St., Toronto, ON M5S 1B2, Canada; email: lorraine.lipscombe@wchospital.ca.

Disclosures: The authors report no relevant financial disclosures.