Association between comorbidity and participation in breast and cervical cancer screening: A systematic review and meta-analysis |
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| Affiliation: | 1. Wellbeing and Preventable Chronic Diseases, Menzies School of Health Research, Charles Darwin University. PO Box 10639, Brisbane, Qld, 4000, Australia;2. School of Medicine, The University of Queensland, 288 Herston Road, Herston Qld 4006, Australia;3. QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston Qld 4006Australia;4. Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley Qld 4006, Australia;5. Centre for Online Health, The University of Queensland, St Lucia, Qld, 4072, Australia;1. Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Denmark;2. Division of Dermatology, University of Louisville, Louisville, KY, USA;3. Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark;1. Dept of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoecho, Sakyoku, Kyoto 606-8501, Japan;2. Dept of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia;3. Dept of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia;4. Dept of Clinical Oncology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia;5. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, Netherlands;1. Cancer Institute NSW, GPO Box 41, Alexandria, Sydney NSW 1435, Australia;2. School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia;3. School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney 2052, Australia;1. Stephenson Cancer Center and Department of Medicine, University of Oklahoma Health Sciences Center, Robert M. Bird Library, 1105 N. Stonewall Ave. LIB 175, Oklahoma City, OK, 73117, United States;2. Dignity Health Cancer Institute at St. Joseph’s Hospital and Medical Center, 500 West Thomas Road Phoenix, AZ, 85013, USA;3. M4-C308, Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA;4. Department of Biostatistics and Epidemiology, Center for American Indian Health Research, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th St, Oklahoma City, OK, 73104, USA;5. Epidemiology Department, Missouri Breaks Industries Research Inc., 118 South Willow St, Eagle Butte, SD, 57625, USA;6. MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD, 20782, USA;7. Georgetown, Howard Universities Center for Clinical and Translational Research, Washington, DC, 2000, USA |
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| Abstract: | BackgroundComorbidity is associated with poor outcomes for cancer patients but it is less clear how it influences cancer prevention and early detection. This review synthesizes evidence from studies that have quantified the association between comorbidity and participation in breast and cervical screening.MethodsPubMed, CINAHL and EMBASE databases were systematically searched using key terms related to cancer screening and comorbidity for original research articles published between 1 January 1991 and 21 March 2016. Two reviewers independently screened 1283 studies that met eligibility criteria related to Population (adult, non-cancer populations), Exposure (comorbidity), Comparison (a ‘no comorbidity’ group), and Outcome (participation in breast cancer or cervical screening). Data was extracted and risk of bias assessed using a standardised tool from the 22 studies identified for inclusion (17 breast; 13 cervical). Meta-analyses were performed for participation in breast and cervical screening, stratified by important study characteristics.ResultsThe majority of studies were conducted in the United States. Results of individual studies were variable. Most had medium to high risk of bias. Based on the three “low risk of bias” studies, mammography screening was less common among those with comorbidity (pooled Odds Ratio 0.66, 95%CI 0.44–0.88). The one “low risk of bias” study of cervical screening reported a negative association between comorbidity and participation.ConclusionWhile a definitive conclusion could not be drawn, the results from high quality studies suggest that women with comorbidity are less likely to participate in breast, and possibly cervical, cancer screening. |
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| Keywords: | Comorbidity Multimorbidity Chronic disease Breast neoplasms Cervical neoplasms Cancer screening Early detection of cancer Mammography Papanicolaou test Meta-analysis |
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