Women with diabetes less likely to get mammograms
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Women with diabetes were significantly less likely to complete a mammogram than women without the condition, according to an analysis of electronic health records from a single institution.
The risk for breast cancer is 20% higher for women with diabetes than those without it, researchers reported.
“Many of the prior studies examining breast cancer screening among women with diabetes are more than a decade old, suffer from small sample sizes or were conducted outside of the United States, limiting generalizability,” Karim Hanna, MD, an assistant professor in the department of family medicine at the University of South Florida, and colleagues wrote in the Journal of the American Board of Family Medicine.
The researchers retrospectively analyzed 16,668 mammogram orders that were filed through the EHR system at the University of South Florida. Of that total, 21.3% of the women had diabetes at the time they received a mammogram order. The women with diabetes had a median age higher than those who did not have diabetes (62 years vs. 57 years) and were less likely to be married (54.6% vs. 60.9%). The cohort with diabetes also had a smaller percentage of non-Hispanic white women (45.5% vs. 69.5%) and a higher percentage of non-Hispanic Black women (42.1% vs. 15.5%).
According to the researchers, 54.5% of all the women in the study completed their mammogram. The women with diabetes were less likely to have completed the procedure than those who did not have diabetes (51.6% vs. 55.3%, respectively). After controlling for age, race and marital status, the women with diabetes had decreased odds for completing their mammogram (adjusted OR = 0.9; 95% CI, 0.83-0.98) than those who did not have diabetes.
In addition, the percentage of all women in the study who received a mammogram dropped as the age group increased, from 57.7% in those aged 40 to 49 years compared with 52.8% in those aged 70 to 74 years.
“However, this trend was not statistically significant in the multivariate model,” the researchers wrote. They also found that white women had the lowest mammogram completion rate while underrepresented women had a greater likelihood of completing their mammogram (aOR for Black women = 1.13; 95% CI, 1.03–1.23; aOR for Asian women = 1.27; 95% CI, 1.08–1.5).
“If we were to do the same study, and expand it, I believe we would find similar results,” Hanna told Healio “many confounding variables” that may explain why women with diabetes are hesitant to get mammograms. However, the “concept of disease burden is what we have to keep in mind,” he said.
“Patients currently handling 10 other issues are less likely to deal with an 11th, particularly an 11th that seems less pressing,” he said.
Hanna said that primary care physicians may be able to increase mammogram completion rates by getting to know their female patients, their needs and their concerns.
“Understanding their social situation may shed light on a lack of transportation, for example. If that is why they are not getting their cancer screening done, perhaps look up resources for imaging near their home or along bus routes,” he said. “Patients often complete requested orders just because their doctor said so. However, we live in a world with plenty of misinformation, and if patients understand the ‘why,’ I believe they are more likely to get their [mammogram] done.”