Adherence to US Preventive Services Task Force recommendations for breast and cervical cancer screening for women who have a spinal cord injury

Abstract

Using longitudinal data with multiple outcome levels, women with SCI were less likely to be fully adherent with receipt of recommended breast and cervical cancer screenings and more likely to have no screenings during the eligible years when compared to women without SCI.

A Primary Care Provider’s Guide to Clinical Needs of Women With Spinal Cord Injury

“…[33][34][35][36] Unfortunately, longitudinal studies show that women with SCI are less likely to have received the recommended exams. 37 Primary care physicians who treat women with SCI may consider exploring local resources, including women's health providers and imaging centers, to advocate for proper accessibility for women with mobility impairments and identify potential barriers to age-appropriate cancer screening. As noted earlier, individuals who have had indwelling catheters for more than 5 to 10 years should have annual cystoscopy for bladder cancer screening.…”

A Primary Care Provider’s Guide to Preventive Health After Spinal Cord Injury

“…16 The literature does not show an increased risk of these cancers among people with SCI versus the general population but does suggest screening does not occur at the same rates. 6,10,14,17,18 This section will discuss SCI-specific considerations to facilitate screening.…”

“…Women with SCI and other disabilities are less likely to receive a mammogram. 6,19 Barriers to obtaining a mammogram include lack of health insurance, factors related to skills/attitudes of health care workers, and physical barriers (inaccessible facilities and equipment). 6,18,20 Suggestions:° Adhere to evidence-based guidelines.° Be knowledgeable of accessible facilities, and coordinate with the facility and staff to ensure they can accommodate individual patient needs.…”

“…A less obvious barrier is the possibility that the clinician lacks expertise with managing unique conditions such as spasticity, bladder issues, and autonomic dysreflexia (AD). 6,20  Monitor blood pressure and have anesthetic gel (lidocaine) to coat the speculum or administer nifedipine 30 minutes prior to procedure if required. 21-23° Referral to a gynecologist may be necessary.° Consultation with a rehabilitation specialist may be necessary (especially in patients with AD).…”

“…[3][4][5] The barriers to care are well described: inaccessibility (e.g., inaccessible office, lack of accessible equipment), lack of primary care physician (PCP) knowledge and confidence in managing SCI, systematic issues (e.g., cost, geographical discrepancies, fragmented care systems), and attitudinal issues (e.g., misconceptions that people with disabilities do not develop the same diseases or cannot undergo the investigations). 4,[6][7][8] McColl and colleagues suggest that ideal primary care for individuals with SCI involves having an accessible premise and an awareness of unmet needs (e.g., sexual health) and performing an annual comprehensive evaluation. 3,9,10 PCPs have an important role in facilitating specialist involvement for secondary conditions and multidisciplinary follow-up for disability-related issues.…”