Predictors of breast cancer screening in women with chronic conditions

Abstract

Background. For women with chronic conditions, care often concentrates on the underlying disorder to the exclusion of cancer screening recommendations. This occurs in the face of lengthening life spans for those with chronic illnesses. Research objective: This study investigated the relationship between chronic illness and the receipt of breast cancer screening services, while controlling for the influence of various established predictors of screening. Data source: Survey data from the 1996 Medical Expenditure Panel Survey (MEPS) Household component. Methods: The influence of chronic illness on the likelihood of having a clinical breast exam (CBE) or mammogram was estimated using logistic regression models. Since a gold standard for measurement of chronicity did not exist, three different measures--number of chronic diseases, Charlson Comorbidity Index, and the presence of mobility and cognitive limitations---were used. Population studied: Women forty years or older (N = 4169). Principal findings: Of the chronicity measures examined, only mobility and cognitive limitations were significant. Women with either limitation were 25 to 30% less likely to be screened even though they had more ambulatory care visits than those without limitations. Neither the number of chronic conditions nor the Charlson Comorbidity Index score were significant predictors of screening. Other significant predictors of screening included age, education, income, insurance, having a usual source of care, and living in a metropolitan statistical area. Conclusions: Although women with mobility and cognitive limitations use more health care services, they are less likely to be screened for breast cancer. A variety of factors including a disease-oriented healthcare system, care priorities, difficulty performing a CBE or mammogram, a lack of insurance, and provider and patient knowledge and attitudes about screening may lead to bias against screening women with mobility anal cognitive limitations. Implications for policy, delivery or practice. Physically inaccessible care sites, inadequate equipment, such as nonadjustable examining tables, and time pressures experienced by providers may impede efforts to provide comprehensive preventive care to women with chronic disabilities. Increasing health care coverage or geographic access may be inadequate if the knowledge and attitudes of providers and patients are not addressed.