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- Title
Breast Cancer Screening Among Women with Comorbidities: A Cross-Sectional Examination of Disparities from the Behavioral Risk Factor Surveillance System.
- Authors
Gatewood, Ashton; Enmeier, Mackenzie; Stephenson, Elise; Austin, Jordyn; Greiner, Benjamin; Hartwell, Micah
- Abstract
Background: Breast cancer is the leading cause of cancer death among women worldwide. Fortunately, frequent mammogram screening among 50- to 69-year-old women decreases breast cancer mortality between 20% and 35%; however, comorbidities, existing in the presence of a breast cancer diagnosis, significantly lower rates of survival. No study to date has analyzed whether certain comorbidities and the biases associated with these diagnoses impact breast cancer screening usage. Objectives: To determine if screening rates differed among individuals with and without diagnoses of any of the following: diabetes, hypertension, cardiovascular disease (CVD), skin cancer, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, or depression compared with healthy patients. Secondarily, we assessed whether multiple comorbidities have an increasing effect on breast cancer screening rates. Methods: Using the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) data sets, we constructed multivariate logistic regression models to determine the adjusted risk ratios (ARRs) of women receiving breast cancer screening with and without comorbidities. To assess our secondary objective, we constructed a regression model to determine the likelihood of individuals with multiple comorbidities (1, 2-4, 5+) having a breast cancer screening. Regression models were adjusted for race, age, healthcare coverage, and education level. A post hoc regression model was conducted to assess the impact of health insurance on breast cancer screening, accounting for all co-occurring diagnoses and sociodemographic variables. Results: Our models showed statistically significant associations among mammogram screening and chronic conditions except for diabetes, CVD, and kidney disease. The models showed that individuals who were obese (ARR, 1.02; 95% CI, 1.01-1.04), had hypertension (ARR, 1.09; 95% CI, 1.01-1.18), a skin cancer diagnosis (ARR, 1.05; 95% CI, 1.03-1.07), or arthritis (ARR, 1.02; 95% CI, 1.01-1.04) were more likely to have completed mammogram screening, whereas individuals with COPD (ARR, 0.93; 95% CI, 0.90-0.95) or depression (ARR, 0.96; 95% CI, 0.94-0.98) were less likely to be screened when controlling for age, race, healthcare insurance, and education. The post hoc analysis showed that the odds of women without healthcare insurance were much less likely (odds ratio [OR], 0.32; 95% CI, 0.28-0.37) to have a breast cancer screening than women with healthcare insurance, and it also indicated that the odds of having a screening increased with higher education. Conclusion: We found that people with co-occurring diagnoses including obesity, diabetes, hypertension, skin cancer, and arthritis completed breast cancer screening more often than those with no comorbidities. Conversely, individuals living with CVD, COPD, and depression were less likely to receive potentially lifesaving breast cancer screening, suggesting biases may be present in women with these diagnoses. Our findings are supported by previous studies showing that breast cancer screening rates are inversely proportional to healthcare insurance and educational attainment. The critical nature of breast cancer screening effectiveness in reducing mortality through early detection highlights the need for greater multidisciplinary care integration to increase preventive health measures in the primary care setting where most chronic conditions are managed, including CVD and depression.
- Subjects
BREAST tumor diagnosis; HYPERTENSION; STATISTICS; CONFIDENCE intervals; CROSS-sectional method; EARLY detection of cancer; DIABETES; CARDIOVASCULAR diseases; RACE; RISK assessment; SKIN tumors; KIDNEY diseases; OBSTRUCTIVE lung diseases; MENTAL depression; DESCRIPTIVE statistics; HEALTH equity; ARTHRITIS; LOGISTIC regression analysis; DATA analysis; COMORBIDITY; INSURANCE; EDUCATIONAL attainment
- Publication
Journal of Oncology Navigation & Survivorship, 2022, Vol 13, Issue 6, p179
- ISSN
2166-0999
- Publication type
Article