Abstract
BackgroundChronic diseases and multimorbidity are common in western countries and associated with increased breast cancer mortality. This study aims to investigate non-participation in breast cancer screening among women with chronic diseases and multimorbidity and the role of time in this association.MethodThis population-based cohort study used regional and national registries. Women who were invited to the first breast cancer screening round in the Central Denmark Region in 2008–09 were included (n = 149,234). Selected chronic diseases and multimorbidity were assessed up to 10 years before the screening date. Prevalence ratios (PR) were used as an association measure.ResultsThe results indicated that women with at least one chronic condition were significantly more likely not to participate in breast cancer screening. In adjusted analysis, a significantly higher likelihood of non-participation was found for women with cancer (PR = 1.50, 95 % CI: 1.40–1.60), mental illness (PR = 1.51, 95 % CI: 1.42–1.60), chronic obstructive pulmonary disease (PR = 1.51, 95 % CI: 1.42–1.62), neurological disorders (PR = 1.24, 95 % CI: 1.12–1.37) and kidney disease (PR = 1.70, 95 % CI 1.49–1.94), whereas women with chronic bowel disease (PR = 0.75, 95 % CI 0.65–0.88) were more likely to participate than women without these disease. Multimorbidity was associated with increased non-participation likelihood. E.g. having 3 or more diseases was associated with 58 % increased non-participation likelihood (95 % CI: 27–96 %). Higher non-participation was also observed for women with severe multimorbidity (PR = 1.53, 95 % CI: 1.23–1.90) and mental-physical multimorbidity (PR = 1.54, 95 % CI: 1.36–1.75).ConclusionIn conclusion, we found a strong association between non-participation in breast cancer screening for some chronic diseases and for multimorbidity. The highest propensity not to participate was observed for women with hospital contacts related to the chronic disease in the period closest to the screening date.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-015-1829-1) contains supplementary material, which is available to authorized users.
Highlights
Chronic diseases and multimorbidity are common in western countries and associated with increased breast cancer mortality
A significantly higher likelihood of non-participation was found for women with cancer (PR = 1.50, 95 % Confidence interval (CI): 1.40–1.60), mental illness (PR = 1.51, 95 % CI: 1.42–1.60), chronic obstructive pulmonary disease (PR = 1.51, 95 % CI: 1.42–1.62), neurological disorders (PR = 1.24, 95 % CI: 1.12–1.37) and kidney disease (PR = 1.70, 95 % CI 1.49–1.94), whereas women with chronic bowel disease (PR = 0.75, 95 % CI 0.65–0.88) were more likely to participate than women without these disease
In conclusion, we found a strong association between non-participation in breast cancer screening for some chronic diseases and for multimorbidity
Summary
Chronic diseases and multimorbidity are common in western countries and associated with increased breast cancer mortality. This study aims to investigate non-participation in breast cancer screening among women with chronic diseases and multimorbidity and the role of time in this association. Studies have found that comorbidity increases the mortality risk among breast cancer patients [6, 7] which in some studies have been related to the comorbidities rather than to the breast cancer [6, 8]. The cancer prognosis depends on the disease stage at the time of diagnosis [3], and given the increased mortality rate among breast cancer patients with. The association between chronic diseases, multimorbidity and non-participation in breast cancer screening has not been studied sufficiently [9, 10]. Five studies found that multimorbidity increased non-participation [9, 13, 15,16,17], but Heflin et al [10] found in their study that three or more conditions increased the propensity to participate
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