Disability and Participation in Breast and Cervical Cancer Screening: A Systematic Review and Meta-Analysis

Abstract

It is well established that access to preventative care, such as breast or cervical cancer screening, can reduce morbidity and mortality. Certain groups may be missed out of these healthcare services, such as women with disabilities, as they face many access barriers due to underlying inequalities and negative attitudes. However, the data have not been reviewed on whether women with disabilities face inequalities in the uptake of these services. A systematic review and meta-analysis were conducted to compare the uptake of breast and cervical cancer screening in women with and without disabilities. A search was conducted in July 2021 across four databases: PubMed, MEDLINE, Global Health, and CINAHL. Quantitative studies comparing the uptake of breast or cervical cancer screening between women with and without disabilities were eligible. Twenty-nine studies were included, all from high-income settings. One third of the 29 studies (34.5%, n = 10) were deemed to have a high risk of bias, and the remainder a low risk of bias. The pooled estimates showed that women with disabilities have 0.78 (95% CI: 0.72–0.84) lower odds of attending breast cancer screening and have 0.63 (95% CI: 0.45–0.88) lower odds of attending cervical cancer screening, compared to women without disabilities. In conclusion, women with disabilities face disparities in receipt of preventative cancer care. There is consequently an urgent need to evaluate and improve the inclusivity of cancer screening programs and thereby prevent avoidable morbidity and mortality.

Do people with disabilities experience disparities in cancer care? A systematic review

“…Even if sometimes treatment decisions for people with disabilities can be clinically complex, such as the abovementioned case of cognitive impairment with legal consent or non-compliance issues, or when confronted with a disability-related shortened life expectancy or frailty for some syndromes (25), there is no plausible medical justification for such a wide disparity compared to patients without disabilities, and these results raise severe concerns about equality in cancer care. (74) The results of this study are consistent with those of other recent literature reviews (12,24,25,73), showing that people with disabilities experience inequities at several points throughout the cancer care pathway. Screening disparities have been known…”

“…and documented for years: they can vary by disability type, severity, healthcare offer and social or demographic situations, with some differences across countries, but globally there is a largely similar trend of major barriers to screening for people with disability, (12) showing a clear need to improve the inclusiveness of these earlydiagnosis services. (73) Providing equitable cancer care has to start early in the cancer clinical pathway, because delays in receiving a diagnosis tend to lead to late access to treatment and worse outcomes. (74) A frequently observed issue is that new signs and symptoms tend to be attributed to often to the underlying disability, a clinical mistake called "diagnostic overshadowing" (75).…”

“…Eligible outcomes were overall mortality after cancer diagnosis, cancer-related mortality, survival, access to state-of-the-art treatment (defined as intent-to-cure treatment when feasible or guideline-consistent stage-appropriate treatment), type of treatment received (medical vs surgical vs radiation vs. hormonal), invasiveness of treatment, delay of treatment, specialist care utilization, access to pain control prescription and end-of-life hospital use for palliative care. Studies focused on screening for cancer were not eligible, as this question was recently reviewed (29)(30)(31)(32)(33)(34)(35). There were no geographic restrictions.…”

Principles for Service Delivery: Best Practices for Cervical Screening for Women with Disabilities

“… 6 One important group is women with disabilities, who make up a sizeable proportion of the target screening population (eg 18.7% of females in England), 7 and are repeatedly found to be less likely to undergo cervical cancer screening. 8 , 9 …”

Analyzing Global and Regional Cervical Cancer Burden from Unsafe Sex: 1990-2019 Trend Study

“…Among female cancer patients, breast cancer and cervical cancer are the two primary types [5]. In 2017, the global mortality rate attributed to cervical cancer was 7.24 per 100,000 individuals, marking a 4.5% increase compared to 1990.…”