Screening for breast cancer is necessary in patients with learning disability

Access to cancer screening by people with learning disabilities in England 2012/13: information from the Joint Health and Social Care Assessment Framework

“…There is increasing and consistent evidence that people with learning disabilities are less likely to access a range of cancer screening services, including: ' breast self-examinations and mammography (Davies and Duff, 2001;Department of Health, 2011;Djuretic et al, 1999;Glover et al, 2012;Osborn et al, 2012;Piachaud and Rohde, 1998;Truesdale-Kennedy et al, 2011;Willis et al, 2008); and ' bowel and prostate cancer screening (Department of Health, 2011;Osborn et al, 2012).…”

Understanding the use of breast cancer screening services by women with intellectual disabilities

“…Reasons not to attend screening include lack of encouragement by physicians (Grady et al 1992;Nosek & Howland 1997;Miller et al 1998;George 2000), lack of perceived risk (Orton et al 1991;George 2000;Speedy & Hase 2000), fear (Thompson et al 1997), embarrassment (Orton et al 1991;Nosek & Howland 1997), inconvenience (Speedy & Hase 2000), insensitivity of health care workers (Nosek & Howland 1997;Thompson et al 1997;Williams et al 1997), pain or discomfort (Keemers-Gels et al 2000;Andrews 2001;Sapir et al 2003), physical disability (Nosek & Howland 1997), residence in a nursing home and dementia (Marwill et al 1996). Women with intellectual disabilities are among the least frequent users of screening mammography (Cowie & Fletcher 1998;Piachaud & Rohde 1998;Davies & Duff 2001), perhaps because the standard recruitment strategies are not suitable. Active recruitment into mammography programs is generally undertaken based on a mailing list derived from various sources such as general medical practitioner (GP) records or the electoral roll (Ballard-Barbash et al 1999), and for many women with intellectual disability these sources may be inappropriate.…”

“…Active recruitment into mammography programs is generally undertaken based on a mailing list derived from various sources such as general medical practitioner (GP) records or the electoral roll (Ballard-Barbash et al 1999), and for many women with intellectual disability these sources may be inappropriate. For example, in the UK mailing lists are developed from GP records at the discretion of the GP, and women with disabilities may not be included if they are considered unsuitable for mammography (Piachaud & Rohde 1998;Davies & Duff 2001). In Australia, mammography services are coordinated by a federal agency, BreastScreen, with screening programs separately organised by individual states.…”

Patients with learning disability in the community

“…Poor uptake of screening for cancer has been reported in women with learning disability. 9 10 Cognitive difficulties may prevent some of these patients appreciating the benefits of screening, and even those with more independence may be unaware of available medical services 11. There are also practical obstacles to providing screening tests 8.…”

“…Much research in learning disabilities has been on service delivery, particularly in the community, but it now needs to address broader issues and it needs to be published in journals where it can be read by all those offering care, including general practitioners, gynaecologists, dentists, and geriatricians, and not just psychiatrists. One suggestion has been to devolve responsibility for providing services to primary health care, with advocacy10 and the appointment of case managers14 helping within this model. In England the new primary care groups, responsible for medical care in the local community, should be in a good position to tailor services for these patients.…”