Are cervical and breast cancer screening programmes equitable? The case of women with intellectual and developmental disabilities

Abstract

Background Effective cancer screening must be available for all eligible individuals without discrimination. Lower rates of cervical and breast cancer screening have been reported in certain groups compared with women from the general population, such as women with intellectual and developmental disabilities (IDD). Research on the factors explaining those observed differences is crucial to determine whether practices are unfair and could be improved. The aim of this population‐based study was to describe cancer screening utilisation by women with IDD in Ontario, Canada compared with other women in Ontario. The specific objectives were (1) to estimate the rates of cervical and breast cancer screening among eligible women with IDD in Ontario; (2) to compare the rates of cervical and breast cancer screening between eligible women with and without IDD; and (3) to examine if any observed differences between women with and without IDD persist after factors such as age, socio‐economic status, rurality and healthcare utilisation are accounted for. Method This study draws women with IDD from an entire population, and draws a randomly selected comparison group from the same population. It controls for important confounders in cancer screening within the limitations of the data sources. The study was conducted using health administrative databases and registries in Ontario, Canada. Two cohorts were created: a cohort of all women identified as having an IDD and a cohort consisting of a random sample of 20% of the women without IDD. Results The proportion of women with IDD who are not screened for cervical cancer is nearly twice what it is in the women without IDD, and 1.5 times what it is for mammography. Conclusions Findings suggest that women with IDD experience inequities in their access to cancer screening. Public health interventions targeting this population should be implemented.

What influences women with intellectual disabilities to attend breast screening? Experiences of women who have and have not participated

“…They include physical disability, level of intellectual disability, ill health of the woman or carer, moving house, access issues such as transport, capacity to consent, fear of the procedure and embarrassment. These are consistent with those found in the general population (Cobigo et al ., ; Isaacs, ; Lalor & Redmond, ; Parish et al ., ; Pehl & Hunt, ; Poynor, ; Sullivan et al ., , ; Svien et al ., ). To address low uptake, there have been many reported education and training initiatives for health and social care staff to encourage women with intellectual disabilities to attend screening (for a comprehensive review, see Willis et al ., ).…”

Management and prevalence of long‐term conditions in primary health care for adults with intellectual disabilities compared with the general population: A population‐based cohort study

“…The present authors have not identified other studies reporting the management of long‐term conditions in this population. What is clearer is that lower rates of cervical screening and mammography are reported for women with intellectual disabilities compared with the general population (Cobigo et al., ; Kerr, Richards, & Glover, ; Osborn et al., ; Reynolds, Stanistreet, & Elton, ; Wood, ), although mammography screening was found to be comparable to levels in the general population in one study (Biswas, Whalley, Foster, Friedman, & Deacon, ).…”

Screening for cervical cancer in women with disability and multimorbidity: a retrospective cohort study in Ontario, Canada

“…A recent multi-country study showed that disability was consistently more prevalent in the poorest than richest quintiles. 46 In their population-based study, Cobigo and colleagues 47 showed that the proportion of Ontario women with intellectual and developmental disabilities who were not screened for cervical cancer was nearly twice that of women without these disabilities. Multimorbidity has been strongly associated with preventable hospital admissions, and this risk is exacerbated by socioeconomic deprivation.…”