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Impact of socio-economic status on breast cancer screening in women with diabetes: a population-based study


Aims – There is evidence to suggest that mammography rates are decreased in women with diabetes and in women of lower socio-economic status. Because of the strong association between low socio-economic status and diabetes, we explored the extent to which socio-economic status differences explain lower mammography rates in women with diabetes.

Methods – A population-based retrospective cohort study in Ontario, Canada, of women aged 50 to 69 years with diabetes between 1999 and 2010 age matched 1:2 to women without diabetes. Main outcome measure is the likelihood of at least one screening mammogram in women with diabetes within a 36-month period, starting as of either 1 January 1999, their 50th birthday or 2 years after a diabetes diagnosis, whichever came last. Outcomes were compared with those in women without diabetes during the same period as their matched counterparts, adjusting for socio-economic status based on neighbourhood income and other demographic and clinical variables.

Results – Of 504 288 women studied (188 759 with diabetes, 315 529 with no diabetes), 63.8% had a screening mammogram. Women with diabetes were significantly less likely to have a mammogram after adjustment for socio-economic status and other factors (odds ratio 0.79, 95% CI 0.78-0.80). Diabetes was associated with lower mammogram use even in women from the highest socio-economic status quintile (odds ratio 0.79, 95% CI 0.75-0.83).

Conclusions – The presence of diabetes was an independent barrier to breast cancer screening, which was not explained by differences in socio-economic status. Interventions that target patient, provider and health system factors are needed to improve cancer screening in this population.



Chan W, Yun L, Austin PC, Jaakkimainen RL, Booth GL, Hux J, Rochon PA, Lipscombe LL. Diabet Med. 2014; 31(7):806-12. Epub 2014 Apr 11.

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