Are cervical and breast cancer screening programmes equitable? The case of women with intellectual and developmental disabilities.
Women with IDD miss cervical and breast cancer screenings far more often, and the problem is bigger than poverty or age.
01Research in Context
What this study did
Mendonca et al. (2013) looked at every woman in Ontario who had health records. They compared women with intellectual or developmental disabilities to women without. They counted who had a Pap smear or mammogram in the last three years.
What they found
Women with IDD were almost twice as likely to miss cervical screening. They were also one-and-a-half times more likely to miss breast screening. The gap stayed big even after age, income, and neighborhood were held constant.
How this fits with other research
Lim et al. (2016) used the same Ontario files but only looked at women who had been pregnant. Even after pregnancy, women with IDD still lagged ten points behind in cervical screening.
Gregory et al. (2001) saw the same breast-screening gap earlier in smaller group homes. Their survey showed only one-third of older women with ID got mammograms.
Lin et al. (2011) seems to disagree. Their survey of women with physical disabilities found 71% had ever had a Pap smear—higher than the general rate. The difference is disability type: physical versus intellectual. Women with IDD face extra communication and consent hurdles that women with only mobility limits do not.
Why it matters
If you serve adults with IDD, cancer screening is part of health planning. Ask families for permission to check medical records. Add screening reminders to annual ISP reviews. Pair the appointment with a preferred activity and use picture schedules to cut anxiety. One extra prompt can close the gap.
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02At a glance
03Original 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.
Journal of intellectual disability research : JIDR, 2013 · doi:10.1111/jir.12035