The Impact of Morbidity and Disability on Attendance at Organized Breast Cancer–Screening Programs: A Systematic Review and Meta-Analysis

Abstract

Individuals with morbidity, experience worse breast cancer outcomes compared to those without. This meta-analysis assessed the impact of morbidity on breast cancer screening attendance and subsequent early detection (PROSPERO pre-registration CRD42020204918). MEDLINE, PsychInfo and CINAHL were searched. Included articles published from 1988 measured organised breast screening mammography attendance using medical records by women with morbidity compared to those without.. Morbidities were assigned to nine diagnostic clusters. Data were pooled using random-effects inverse meta-analyses to produce odds ratios (OR) for attendance.. 25 study samples (28 articles) were included. Data were available from 17,755,075 individuals including at least 1,408,246 participants with one or more conditions;16,250,556 had none. Individuals with any morbidity had lower odds of attending breast screening compared to controls (k=25,OR=0.76[95% CI 0.70-0.81],p=<0.001,I2=99%). Six morbidity clusters had lower odds of attendance. The lowest were for neurological, psychiatric and disability conditions; odds ratios ranged from 0.45-0.59 compared to those without. Morbidity presents a clear barrier for breast screening attendance, exacerbating health inequalities and, includes a larger number of conditions than previously identified. Consensus is required to determine a standardised approach on how best to identify those with morbidity and determine solutions for overcoming barriers to screening participation based on specific morbidity profiles.

Barriers and facilitators for people with severe mental illness accessing cancer screening: A systematic review

“…Access to breast and cervical cancer screening was also found to be difficult for PwSMI, by needing access to public transportation to attend the appointment, knowing how to attend an appointment at an unfamiliar location, having the time and motivation to attend the appointment, and more specifically to the USA, the insurance and costs to have the screening. McWilliams 63 also identified these accessibility factors as barriers to attending cancer screening, as well as other factors that our review did not highlight, including PwSMI having low value in their own health and the fear of leaving home. In an attempt to reduce these barriers, initiatives have been implemented where people can choose where to complete cervical cancer screening, such as local sexual health clinics or walk‐in centres 64 which could then reduce the travel and associated cost of transportation.…”

Cancer inequalities experienced by people with disability: a systematic review protocol

“…10 Emerging evidence shows that people with disability face challenges in accessing health services like cancer screening that could help with early diagnoses of existing cancer. [11][12][13] Barriers to screening access could lead to cancer patients with disability presenting with later-stage disease, which reduces treatment options and lowers the survival rate in comparison to people without disability. 14 The first step to promoting equitable cancer-related outcomes for people with disability is to comprehensively understand the current state of evidence that quantifies cancer service and outcome inequalities to assess gaps in our knowledge and understand where inequalities are emerging.…”

“…Emerging evidence shows that people with disability face challenges in accessing health services like cancer screening that could help with early diagnoses of existing cancer 11–13. Barriers to screening access could lead to cancer patients with disability presenting with later-stage disease, which reduces treatment options and lowers the survival rate in comparison to people without disability 14…”

Clinical Multiteam System Composition and Complexity Among Newly Diagnosed Early-Stage Breast, Colorectal, and Lung Cancer Patients With Multiple Chronic Conditions: A SEER-Medicare Analysis

“…[2][3][4] Having MCC at cancer diagnosis is associated with health and health care disparities, including later-stage cancer diagnosis, treatment delays, forgoing curative-intent treatment, disruptions in chronic disease management, morbidity, and mortality. [5][6][7][8][9] Team-based care, a cornerstone of high-quality care for almost two decades, 10 may be an important avenue for addressing health disparities because it, ideally, encourages coordinated, collaborative management by a multidisciplinary clinical team-of-teams, or a multi-team system (MTS), working to accomplish shared patient goals, often across disciplinary, health system, and care setting boundaries. 11,12 The composition of the clinical MTS involved in a particular patient's care can be characterized on the basis of several attributes, including the number of clinicians or clinical teams involved, diversity of specialties, and/or the diversity of practice settings or health systems involved.…”

“…2-4 Having MCC at cancer diagnosis is associated with health and health care disparities, including later-stage cancer diagnosis, treatment delays, forgoing curative-intent treatment, disruptions in chronic disease management, morbidity, and mortality. 5-9…”