Chronic conditions discourage women from keeping up with screening mammography

Women living with chronic health problems tend to put off screening for breast cancer, possibly due to treatment fatigue, according to a study conducted at Massachusetts General Hospital and published online Dec. 19 in the Journal of Women’s Health.

In presenting their findings, Randy Miles, MD, MPH, and colleagues encouraged healthcare workers to begin thinking of frequent visits by these women as opportunities to coax them into maintaining a regular mammography schedule.

Miles and team arrived at their recommendation after reviewing the cases of 9,575 women between 50 and 64 who were screened for breast cancer in 2005 and had at least eight years of follow-up.

Pulling demographic and clinical information from Mass General’s centralized patient data registry, the researchers found 1,669 women (17.7 percent) had been diagnosed, at least three months prior to their last mammogram, with either atrial fibrillation, congestive heart failure, chronic obstructive pulmonary disease (COPD), diabetes mellitus type II, heart disease, peripheral vascular disease—or more than one of any of the above.

Overall, the women with one or more of these diseases had somewhat fewer screening mammography records than women who had none of the diseases.

Drilling down into specific chronic conditions, Miles and colleagues found women who had congestive heart failure, COPD or diabetes mellitus type II had fewer screening mammography records than women without each of those individual diagnoses.

More tellingly still, the more chronic medical conditions a woman had, the less likely she was to receive routine breast screening—while women who had just one of the diseases were screened at a rate comparable to that of those with none.

“Despite experiencing longer life expectancies, women with specific chronic diseases may experience additional barriers to uptake of mammography screening, which is likely compounded by the comorbidity burden of being simultaneously treated for multiple chronic conditions,” Miles et al. concluded. “Increased health care interactions seen in this group may represent missed opportunities to improve screening adherence.”