CHRONIC DISEASE AS A BARRIER TO BREAST AND CERVICAL-CANCER SCREENING

OBJECTIVE: To assess whether chronic disease is a barrier to screening for breast and cervical cancer. DESIGN: Structured medical record rev iew of a retrospectively defined cohort. SETTING: Two primary care cli nics of one academic medical center. PATIENTS: All eligible women at l east 43 years of age seen during a B-month period in each of the two s tudy clinics (n = 1,764), MEASUREMENTS AND MAIN RESULTS: Study outcome s were whether women had been screened: for mammogram, every 2 years f or 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 ind ex of comorbidity, adapted from Charlson (0 for no disease, maximum in dex of 8 among our patients), and specific chronic diseases were the m ain independent variables. Demographics, clinic use, insurance, and cl inical data were covariates. In the appropriate age groups for each te st, 58% of women had a mammogram, 43% had a CBE, and 66% had a Pap sme ar. As comorbidity increased, screening rates decreased (p < .05 for l inear 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 sm ears (p = .002). The rate of mammography in women with stable angina w as only two fifths of that in women without. CONCLUSIONS:Among women w ho sought outpatient care, screening rates decreased as comorbidity in creased. Whether clinicians and patients are making appropriate decisi ons about screening is not known.