Wang K H, Thompson T A, Galusha D, Friedman H, Nazario C M, Nunez M, Maharaj R G, Adams O P, Nunez-Smith M
Equity Research and Innovation Center, Yale University School of Medicine, New Haven, USA.
School of Public Health, University of Puerto Rico, San Juan, Puerto Rico.
Cancer Causes Control. 2018 Mar;29(3):315-324. doi: 10.1007/s10552-018-1005-4. Epub 2018 Feb 8.
The Caribbean population faces a growing burden of multiple non-communicable chronic diseases (NCDs). Breast cancer is the leading cause of cancer death for women in the Caribbean. Given the substantial burden of NCDs across the region, cancer prevention and control strategies may need to be specifically tailored for people with multiple co-morbidities. Preventive screening, such as timely mammography, is essential but may be either facilitated or hampered by chronic disease control. The main objective of this study is to examine the relationship between a chronic disease and timely breast cancer screening.
We conducted a cross-sectional data analysis using baseline data from the Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study-ECS. Our independent variables were presence of chronic diseases (hypertension or diabetes), defined as having been told by a clinical provider. Our dependent variable was timely screening mammography, as defined by receipt of mammography within the past 2 years. We examined bivariate and multivariate associations of covariates and timely screening mammography.
In our sample (n = 841), 52% reported timely screening mammography. Among those with timely screening, 50.8% reported having hypertension, and 22.3% reported having diabetes. In our bivariate analyses, both diabetes and hypertension were associated with timely screening mammography. In partially adjusted models, we found that women with diabetes were significantly more likely to report timely screening mammography than women without diabetes. In our fully adjusted models, the association was no longer significant. Having a usual source of healthcare and a woman's island of residence were significantly associated with timely screening mammography (p < 0.05).
We found that half of eligible women received timely screening mammography. Diabetes and hypertension, though common, are not associated with timely screening mammography. Usual source of care remains an important factor to timely breast cancer screening.
加勒比地区人口面临着多种非传染性慢性病（NCDs）日益加重的负担。乳腺癌是加勒比地区女性癌症死亡的主要原因。鉴于该地区非传染性慢性病负担沉重，癌症预防和控制策略可能需要专门针对患有多种合并症的人群制定。预防性筛查，如及时进行乳房X光检查，至关重要，但可能会受到慢性病控制情况的促进或阻碍。本研究的主要目的是探讨慢性病与及时进行乳腺癌筛查之间的关系。
我们使用东加勒比健康结果研究网络（ECHORN）队列研究-ECS的基线数据进行了横断面数据分析。我们的自变量是慢性病（高血压或糖尿病）的存在情况，定义为临床医生告知患有此类疾病。我们的因变量是及时进行乳房X光检查，定义为在过去2年内接受过乳房X光检查。我们研究了协变量与及时进行乳房X光检查的双变量和多变量关联。
在我们的样本（n = 841）中，52%的人报告及时进行了乳房X光检查。在及时进行筛查的人群中，50.8%的人报告患有高血压，22.3%的人报告患有糖尿病。在我们的双变量分析中，糖尿病和高血压均与及时进行乳房X光检查有关。在部分调整模型中，我们发现患有糖尿病的女性比未患糖尿病的女性更有可能报告及时进行乳房X光检查。在我们的完全调整模型中，这种关联不再显著。有常规医疗保健来源以及女性居住的岛屿与及时进行乳房X光检查显著相关（p < 0.05）。
我们发现一半符合条件的女性接受了及时的乳房X光检查。糖尿病和高血压虽然常见，但与及时进行乳房X光检查无关。常规医疗保健来源仍然是及时进行乳腺癌筛查的一个重要因素。
