Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 1998 Jun;13(6):357-65.
doi: 10.1046/j.1525-1497.1998.00115.x.

Chronic disease as a barrier to breast and cervical cancer screening

C I Kiefe  1 , E Funkhouser, M N Fouad, D S May
Affiliations

Chronic disease as a barrier to breast and cervical cancer screening

C I Kiefe et al. J Gen Intern Med. 1998 Jun.

Abstract

Objective: To assess whether chronic disease is a barrier to screening for breast and cervical cancer.

Design: Structured medical record review of a retrospectively defined cohort.

Setting: Two primary care clinics of one academic medical center.

Patients: All eligible women at least 43 years of age seen during a 6-month period in each of the two study clinics (n = 1,764).

Measurements and main results: Study outcomes were whether women had been screened: for mammogram, every 2 years for ages 50-74; for clinical breast examinations (CBEs), every year for all ages; and for Pap smears, every 3 years for ages under 65. An index of comorbidity, adapted from Charlson (0 for no disease, maximum index of 8 among our patients), and specific chronic diseases were the main independent variables. Demographics, clinic use, insurance, and clinical data were covariates. In the appropriate age groups for each test, 58% of women had a mammogram, 43% had a CBE, and 66% had a Pap smear. As comorbidity increased, screening rates decreased (p < .05 for linear trend). After adjustment, each unit increase in the comorbidity index corresponded to a 17% decrease in the likelihood of mammography (p = .005), 13% decrease in CBE (p = .006), and 20% decrease in Pap smears (p = .002). The rate of mammography in women with stable angina was only two fifths of that in women without.

Conclusions: Among women who sought outpatient care, screening rates decreased as comorbidity increased. Whether clinicians and patients are making appropriate decisions about screening is not known.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Proportion of women in appropriate age group who were screened by Charlson comorbidity category. See Methods section for definitions.
See this image and copyright information in PMC

Comment in

  • Screening for disease in older people.
    Sox HC. Sox HC. J Gen Intern Med. 1998 Jun;13(6):424-5. doi: 10.1046/j.1525-1497.1998.00126.x. J Gen Intern Med. 1998. PMID: 9669575 Free PMC article. No abstract available.

References

    1. La Vecchia C, Decarli A, Gentile A, et al. Pap smear and the risk of cervical neoplasia: quantitative estimates from a case-control study. Lancet. 1984;2:779–82. - PubMed
    1. Kerlikowske K, Grady D, Rubin SM, Sandrock C, Ernster VL. Efficacy of screening mammography. A meta-analysis. JAMA. 1995;273(2):149–54. - PubMed
    1. US Preventive Services Task Force . Guide to Clinical Prevention Services. 2nd ed. Baltimore, Md: Williams & Wilkins; 1996.
    1. Anderson LM, May DS. Has the use of the cervical, breast, and colorectal cancer screening increased in the United States? Am J Public Health. 1995;85(6):840–2. - PMC - PubMed
    1. Trends in cancer screening–-United States, 1987 and 1992. MMWR. 1996;45(3):57–61. - PubMed

Publication types