Women with Diabetes Had Too Few Mammograms

Lack of mammograms among women with diabetes not tied to financial status

(RxWiki News) It is recommended that women have regular breast cancer screening. Some women, who are more in need of screening than others, may be getting screened less often than they should, research shows.

This new research found that women with diabetes in Canada were less likely to have mammograms than women without diabetes, even when socioeconomics were taken into consideration.

"Ask your doctor what mammogram guidelines apply to you."

This research was led by Lorraine Lipscombe, MD, of Women’s College Research Institute in Toronto, Ontario, Canada.

The researchers studied Ontario women who were 50 to 69 years of age between 1999 and 2010. They age-matched the women with diabetes with twice as many women who did not have diabetes. These researchers wanted to see how many women with diabetes had one screening mammogram in a 36-month period.

In Canada, it is recommended that women who are 50 or older have a mammogram every three years. At the time of the study, it was recommended that these women have screening every two years, but the researchers chose 36 months to reflect the new recommendations.

In the United States, mammography recommendations vary. For example, the American Cancer Society recommends annual mammograms beginning at age 40. The U.S. Preventive Services Task Force recommends screening every two years beginning at age 50. Women with a family history of breast cancer are told to have mammography that begins earlier. Every woman should discuss this issue individually with her doctor.

This study included 188,759 women with diabetes and 315,529 women without diabetes. Information on demographics and deaths were obtained from the Registered Persons Database and the Ontario Breast Cancer Screening Program.

The researchers went into the study expecting to find that the reason women with diabetes had fewer mammograms was tied to the socioeconomic status of the women, even though mammograms are free in Canada. They found that socioeconomic status did not explain the discrepancy.

The researchers did find that the less money a woman had, the less likely she was to have a mammogram. Yet, despite this finding, the wealthier women with diabetes still had fewer mammograms than wealthier women without diabetes.

The study showed that 14 percent fewer women with diabetes had mammograms every three years than women who did not have diabetes.

Women with diabetes have a higher risk for breast cancer and a poorer prognosis once diagnosed, the researchers noted. In addition to metabolic factors as a result of the diabetes that influence tumor growth and progression, part of the reason may also be that these women do not have regular mammograms, they wrote.

The authors of this study suggested that one reason women with diabetes were less likely to have mammograms may be that they see many different health care providers, unlike women who see only their primary doctor who will likely think to ask about mammograms.

Graham Colditz, MD, of the Washington University School of Medicine, was not surprised by the study's findings. “Like some pervious studies, these province-wide data from Ontario show that women with diabetes have lower levels of mammography screening than those without — and this is independent of socioeconomic status,” he said in an email.

“Diabetes, like other chronic conditions, may lead to less regular screening, in part because care may be fragmented among providers," Dr. Colditz told dailyRx News.

“Also seen again in this study is the fact that women with lower socioeconomic status have fewer mammograms, even after controlling for access to care. We need better systems to implement screening and preventive guidelines more generally,” he said. “These must be implemented through targeting patient, provider, and the health system.”

In a press release, Dr. Lipscombe said, "Given the increasing demands on family doctors today who are seeing more patients than ever before, preventive issues like cancer screening are often overlooked. Programs that offer incentives and reminders for cancer screening or allow for self-referral may help ensure all women are getting their mammograms when they need them most."

This study was published April 11 in Diabetic Medicine.

The authors did not disclose any conflicts of interest.

Review Date: 
April 14, 2014