Breast cancer screening for women with intellectual disabilities is less common

Among women eligible for the National Breast Cancer Screening Program in Denmark, women with intellectual disabilities were less likely to undergo recommended screening, according to findings published in . JAMA network open.

According to research context, women with intellectual disability have higher overall and breast cancer-specific mortality rates compared to women without intellectual disability. have been shown to have low screening rates, but no studies have evaluated rates in Denmark, where participation in national screening programs is high.

“The Danish health system is tax-funded and all citizens have universal access to free health services, including cancer screening.” trine Alleleph Horseboldoctorate, Assistant professor of public health epidemiology at the University of Southern Denmark in Copenhagen and a colleague wrote. “Thus, it is an ideal environment to assess participation, apart from barriers caused by income and access to health care.”

method

Horsbøl et al. evaluated women’s participation in the Danish national breast cancer screening program from its inception in 2007 until the first censorship event occurred. Censoring events included death, diagnosis of carcinoma in situ or breast cancer, and termination of the study period on March 31, 2021.

Women were included in the study aged between 1941 and 1967, as women entered the study between the ages of 50 and 69 through 2017. All women were invited to participate in screening every two years.

Researchers used the Danish National Patient Registry, the Danish Central Research Registry of Psychiatry, and the Danish Cerebral Palsy Registry to identify 5,595 women with an intellectual disability, defined as a diagnosis of intellectual disability. bottom. cerebral palsy with intellectual disability; Down’s syndrome; and/or certain metabolic disorders, congenital malformations and/or chromosomal disorders that may lead to intellectual disability.

Women whose permanent residency was an institution for the mentally handicapped were also included. Some women were included in more than one of these groups.

Women with intellectual disability were age-matched with 49,423 women without intellectual disability.

findings

Most (82%) women in the intellectual disability group were diagnosed with intellectual disability, followed by Down syndrome (10%), cerebral palsy with intellectual disability (4%), metabolic disorders (2%), congenital Malformations and/or chromosomal abnormalities followed. disability (1%). Also, her 30% of women with intellectual disabilities were found through institutions.

Overall, 1,425 (25%) women with intellectual disability and 30,480 (62%) women without intellectual disability met screening guidelines. A woman with an intellectual disability was nearly five times more likely to not be screened than a woman without an intellectual disability (45% vs. 13%; adjusted OR = 4.9; 95% CI, 4.6-5.22).

Subgroup analysis

Among women with intellectual disability, women with Down syndrome had the lowest rate of complete adherence to screening recommendations (n ​​= 78; 14%) and women with cerebral palsy with intellectual disability (n = 32 ; 16%). Women in both subgroups were nearly 11 times more likely not to be screened than women without intellectual disability (Down syndrome aOR = 10.98; 95% CI 8.95–13.47; cerebral palsy aOR = 11.31; 95% CI 7.99–16.01).

Moreover, the more severe the intellectual disability diagnosis, the more likely they were not screened. In an adjusted analysis, women with mild intellectual disability were three times more likely not to be tested (aOR = 3.36; 95% CI, 3.05–3.7) and women with severe intellectual disability were more likely to be tested. 30 times more likely not to (aOR = 31.28; 95% CI, 21.98-44.52) versus women without intellectual disability.

“These findings suggest a need for research that focuses on the barriers and facilitators of women with intellectual disabilities in participating in breast cancer screening in the Danish setting,” Horsbøl and colleagues wrote. I’m here. “Such knowledge may facilitate coordinated guidelines and approaches for breast cancer screening in this group of women.”