Patterns and predictors of screening for breast and cervical cancer in women with CKD
Wong G, Hayward JS, McArthur E, Craig JC, Nash DM, Dixon SN, Zimmerman D, Kitchlu A, Garg AX. Clin J Am Soc Nephrol. 2017; 12(1):95-104. Epub 2016 Dec 29.
Background and Objectives — Breast and cervical cancer is prevalent in women with chronic kidney disease (CKD), but it is uncertain how often screening for these cancers is undertaken given concerns the benefits of screening may be less and the harms greater in women with CKD than in the general population. We examined patterns of breast and cervical cancer screening in women based on CKD stage and age, and assessed predictors of screening.
Design, Setting, Participants and Measurements — We conducted two population-based cohort studies (breast and cervical cancer screening) from 2002 to 2013 using linked administrative healthcare data from Ontario, Canada. A total of 141,326 and 324,548 women were included in the breast and cervical cancer screening cohorts.
Results — The two-year cumulative incidences were 61% amongst women without CKD, 54% for those with CKD 3a-b, 37% for CKD 4-5, and 26% for women on dialysis. Similar patterns were observed for the three-year cumulative incidence of cervical cancer screening. The associations of breast and cervical cancer screening with CKD were modified by age and CKD stage, where lower incidence of screening in women with advanced CKD compared to no CKD was most pronounced in older age groups (p<0.001). Older age, higher comorbidity burden and lower income groups were associated with a lower rate of screening.
Conclusions — Most women with advanced CKD do not receive breast or cervical cancer screening. A better understanding of patient and health professional preferences towards cancer screening in CKD is needed, along with the outcomes of such screening.
Kidney and urinary tract disorders