Constantinou Panayotis, Dray-Spira Rosemary, Menvielle Gwenn
Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
Université Paris-Saclay, Université Paris-Sud, UVSQ, INSERM, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France.
BMC Cancer. 2016 Mar 31;16:255. doi: 10.1186/s12885-016-2295-0.
Comorbidity at the time of diagnosis is an independent prognostic factor for survival among women suffering from cervical or breast cancer. Although cancer screening practices have proven their efficacy for mortality reduction, little is known about adherence to screening recommendations for women suffering from chronic conditions. We investigated the association between eleven chronic conditions and adherence to cervical and breast cancer screening recommendations in France.
Using data from a cross-sectional national health survey conducted in 2008, we analyzed screening participation taking into account self-reported: inflammatory systemic disease, cancer, cardiovascular disease, chronic respiratory disease, depression, diabetes, dyslipidemia, hypertension, obesity, osteoarthritis and thyroid disorders. We first computed age-standardized screening rates among women who reported each condition. We then estimated the effect of having reported each condition on adherence to screening recommendations in logistic regression models, with adjustment for sociodemographic characteristics, socioeconomic position, health behaviours, healthcare access and healthcare use. Finally, we investigated the association between chronic conditions and opportunistic versus organized breast cancer screening using multinomial logistic regression.
The analyses were conducted among 4226 women for cervical cancer screening and 2056 women for breast cancer screening. Most conditions studied were not associated with screening participation. Adherence to cervical cancer screening recommendations was higher for cancer survivors (OR = 1.73 [0.98-3.05]) and lower for obese women (OR = 0.73 [0.57-0.93]), when accounting for our complete range of screening determinants. Women reporting chronic respiratory disease or diabetes participated less in cervical cancer screening, except when adjusting for socioeconomic characteristics. Adherence to breast cancer screening recommendations was lower for obese women and women reporting diabetes, even after accounting for our complete range of screening determinants (OR = 0.71 [0.52-0.96] and OR = 0.55 [0.36-0.83] respectively). The lower breast cancer screening participation for obese women was more pronounced for opportunistic than for organized screening.
We identified conditions associated with participation in cervical and breast cancer screening, even when accounting for major determinants of cancer screening. Obese women participated less in cervical cancer screening. Obese women and women with diabetes participated less in mammographic screening and organized breast cancer screening seemed to insufficiently address barriers to participation.
诊断时的合并症是宫颈癌或乳腺癌女性患者生存的独立预后因素。尽管癌症筛查实践已证明其在降低死亡率方面的有效性，但对于患有慢性病的女性对筛查建议的依从性却知之甚少。我们调查了法国11种慢性病与宫颈癌和乳腺癌筛查建议依从性之间的关联。
利用2008年全国横断面健康调查的数据，我们分析了筛查参与情况，考虑了自我报告的：炎症性全身性疾病、癌症、心血管疾病、慢性呼吸道疾病、抑郁症、糖尿病、血脂异常、高血压、肥胖、骨关节炎和甲状腺疾病。我们首先计算了报告每种疾病的女性的年龄标准化筛查率。然后，我们在逻辑回归模型中估计报告每种疾病对筛查建议依从性的影响，并对社会人口学特征、社会经济地位、健康行为、医疗保健可及性和医疗保健使用情况进行了调整。最后，我们使用多项逻辑回归研究了慢性病与机会性乳腺癌筛查和组织性乳腺癌筛查之间的关联。
对4226名进行宫颈癌筛查的女性和2056名进行乳腺癌筛查的女性进行了分析。研究的大多数疾病与筛查参与情况无关。在考虑了我们所有的筛查决定因素后，癌症幸存者对宫颈癌筛查建议的依从性更高（OR = 1.73 [0.98 - 3.05]），而肥胖女性的依从性较低（OR = 0.73 [0.57 - 0.93]）。报告患有慢性呼吸道疾病或糖尿病的女性参与宫颈癌筛查的比例较低，但在调整社会经济特征后除外。即使在考虑了我们所有的筛查决定因素后，肥胖女性和报告患有糖尿病的女性对乳腺癌筛查建议的依从性也较低（分别为OR = 0.71 [0.52 - 0.96]和OR = 0.55 [0.36 - 0.83]）。肥胖女性乳腺癌筛查参与率较低在机会性筛查中比在组织性筛查中更为明显。
我们确定了与宫颈癌和乳腺癌筛查参与相关的疾病，即使在考虑了癌症筛查的主要决定因素之后。肥胖女性参与宫颈癌筛查的比例较低。肥胖女性和糖尿病女性参与乳腺钼靶筛查的比例较低，而且组织性乳腺癌筛查似乎没有充分解决参与的障碍。
