Breast cancer screening less likely in women with diabetes

A new study from the Institute for Clinical Evaluative Sciences (ICES) has found that women with diabetes are significantly less likely to receive mammograms to screen for breast cancer, compared with women who do not have diabetes, despite more healthcare visits.

From 1999 to 2002, researchers tracked women aged 50 to 67 (the target age for breast cancer screening), who were free of breast cancer, until their first mammogram in a two-year period. They compared mammogram rates between 69,168 women who had diabetes and 663,519 women without diabetes, to examine whether the presence of diabetes affects mammography use to screen for breast cancer.

Overall, only 46.5% of women had at least one screening mammogram. Approximately one-third fewer women with diabetes had a mammogram than women without diabetes. In addition, the odds of having a mammogram remained significantly reduced for women with diabetes even after taking into account their age, income, where they lived, additional illnesses, frequency of primary care visits, specialist care, and having a regular care provider.

“Our results translate into an extra 19,829 women with diabetes in Ontario who were not screened over a two-year period yet might have been if they were free of diabetes, and about 120 new breast cancer cases that may have been missed over this period,” said study lead author and ICES research fellow Dr. Lorraine Lipscombe.

“Diabetes care has become significantly more complex and time-consuming over the past decade due to a shift toward more intensive therapeutic and lifestyle interventions. This sort of chronic disease management could be diminishing the attention paid to long-term disease prevention for conditions such as breast cancer,” said Dr. Lipscombe.

“However, simple inexpensive interventions such as letters to patients, mailed educational materials, and phone calls have been shown to significantly improve mammography screening rates. It’s important that we develop more of these sorts of standardized strategies to not only improve breast cancer screening rates in women with complex diseases such as diabetes, but across the target screening population.”

The study, “Reduced screening mammography among women with diabetes”, is in the Oct. 10, 2005 issue of the Archives of Internal Medicine.

Author affiliations: ICES (All authors); Department of Medicine, University of Toronto (Drs. Booth and Hux); Sunnybrook and Women’s College Health Sciences Centre (Drs. Lipscombe and Hux); St. Michael’s Hospital (Dr. Booth).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. 

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