Factors influencing the mammography utilization among Taiwanese women with intellectual disabilities, a nationwide population-based study.
Taiwanese women with ID get mammograms at one-third the national rate, but Singapore shows the gap can close fast when barriers are removed.
01Research in Context
What this study did
Lai et al. (2014) looked at every woman with intellectual disability in Taiwan who was 50-69 years old. They asked: how many got the free breast X-ray the government offers? They also checked if things like education level or having a regular doctor changed the odds.
The team pulled national insurance records, so no one was missed. They compared the ID group with the general female population of the same age.
What they found
Only 4 out of every 100 women with ID had a mammogram in the study year. That is less than half the rate for other Taiwanese women.
The women least likely to go had profound ID, no schooling, or had never used any preventive care before.
How this fits with other research
Griffin et al. (2026) followed the same women forward. When some later got breast cancer, the ones who had a family-doctor interview were far more likely to receive proper treatment. The 4 % screening gap shown by Hsien-Tang now looks even more serious, because it starts a care cascade.
Chang et al. (2014) and Tsai et al. (2012) found the same pattern in kids: only 11 % got outpatient PT and only 38 % got any preventive visit. Across ages, Taiwanese people with disabilities use high-cost crisis care yet skip low-cost prevention.
Van Hanegem et al. (2014) flips the script. In Singapore a free, on-site heart-disease screening for adults with ID jumped from 18 % to 90 % in three months. The 4 % mammography rate is not inevitable; it is a systems problem that can be fixed.
Why it matters
If you serve adults with ID, treat the 4 % figure as a baseline, not a life sentence. Schedule the mammogram yourself, send picture reminders, and loop in the family doctor. One extra step during an already-planned visit can start the cancer-care chain that W et al. showed saves lives later.
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02At a glance
03Original abstract
Women with intellectual disabilities (ID) have cognitive impairment and communication difficulties; for both caregivers and clinical personnel, discovering the early symptoms of breast cancer among women with ID is challenging. The mammography utilization rate of women with ID was significantly lower than that of women in the general population. This study employed a 2008 database of people with disabilities in Taiwan as a research target and analyzed the mammography utilization rate of women with ID aged 50–69 years. In addition, relevant factors influencing mammography utilization among women with ID were also investigated. A total of 4370 participants were recruited and the majority were illiterate or had elementary-level educations (82.27%). The majority of the participants had ID that was more severe than mild (83.80%). The mammography utilization rate of women with ID was 4.32%, which was significantly lower than that of women in the general population (12%). The mammography utilization rate among women with ID who were married, had higher education levels, and had been diagnosed with cancer, diabetes, or mild ID was significantly higher. However, the mammography utilization rate among women with ID, who had elementary-level educations or were illiterate, was only 4.03%. The utilization rate among women with profound ID was only 2.65%. Women with ID who had undergone pap smears or had utilized adult preventive health services demonstrated a significantly higher mammography utilization rate. This study identified that education level, a diagnosis of diabetes, and the application of pap smears or adult preventive health services were primary factors that influenced the mammography utilization rate among women with ID. This study also observed that in Taiwan, the mammography utilization rate of women with ID was lower than that of pap smears and adult preventive health services, and was only half of that of people with disabilities. An unequal situation existed in regard to the acceptance of breast cancer screening among women with ID, and a different form of strategic planning must be adopted in public health policy. Because ID differs from other disabilities and most women with ID are illiterate, tailored courses are required to train primary caregivers and clinical personnel in providing knowledge and services. The objectives are to diagnose breast cancer at an early stage to decrease the risk of mortality and ensure their rights to health.
Research in developmental disabilities, 2014 · doi:10.1016/j.ridd.2014.08.019