Women with disabilities (WWD) face significant barriers accessing healthcare, which may affect rates of routine preventive services. We examined the relationship between disability status and routine breast and cervical cancer screening among middle-aged and older unmarried women and the differences in reported quality of the screening experience.
Methods:
Data were from a 2003–2005 cross-sectional survey of 630 unmarried women in Rhode Island, 40–75 years of age, stratified by marital status (previously vs. never married) and partner gender (women who partner with men exclusively [WPM] vs. women who partner with women exclusively or with both women and men [WPW]).
Results:
WWD were more likely than those without a disability to be older, have a high school education or less, have household incomes <$30,000, be unemployed, and identify as nonwhite. In addition, WWD were less likely to report having the mammogram or Pap test procedure explained and more likely to report that the procedures were difficult to perform. After adjustment for important demographic characteristics, we found no differences in cancer screening behaviors by disability status. However, the quality of the cancer screening experience was consistently and significantly associated with likelihood of routine cancer screening.
Conclusions:
Higher quality of cancer screening experience was significantly associated with likelihood of having routine breast and cervical cancer screening. Further studies should explore factors that affect quality of the screening experience, including facility characteristics and interactions with medical staff.
Get full access to this article
View all access options for this article.
References
1.
WaldropJ, SternSM. Disability status: 2000. Census 2000 brief. U.S. Department of Commerce Economics and Statistics Administration U.S. Census Bureau, 2003.
2.
VerbruggeLM, JetteAM. The disablement process. Soc Sci Med, 1994; 38:1–14.
3.
NosekMA, YoungME, RintalaDH, HowlandBA, FoleyCC, BennettJL. Barriers to reproductive health maintenance among women with physical disabilities. J Womens Health, 1995; 4:505–518.
4.
BeckerH, StuifbergenA, TinkleM. Reproductive health care experiences of women with physical disabilities: A qualitative study. Arch Phys Med Rehabil, 1997; 78,SupplS-26.
5.
NosekMA, HowlandCA. Breast and cervical cancer screening among women with physical disabilities. Arch Phys Med Rehabil, 1997; 78,(Suppl)S-39.
6.
ShabasD, WeinrebH. Preventive health care in women with multiple sclerosis. J Womens Health Gend Based Med, 2000; 9:389–395.
7.
DeJongG, PablsboS, BeattyP, JonesG, KrollT, NeriM. The organization and financing of services for persons with disabilities. Milbank Q, 2002; 80:261–301.
8.
BeckerH, StuifbergenA. What makes it so hard? Barriers to health promotion experienced by people with multiple sclerosis and polio. Fam Community Health, 2005; 27:75–85.
9.
VergerP, AulagnierM, SouvilleMet al.Women with disabilities: General practitioners and breast cancer screening. Am J Prev Med, 2005; 28:215–220.
10.
WelnerS. Screening issues in gynecologic malignancies for women with disabilities critical considerations. J Womens Health, 1998; 7:281–285.
11.
DuffySW, TabárL, SmithRA. The Mammographic Screening Trials: Commentary on the recent work by Olsen and Gøtzsche. CA Cancer J Clin, 2002; 52:68–71.
12.
BlusteinJ, WeissLJ. The use of mammography by women aged 75 and older: Factors related to health, functioning and age. J Am Geriatr Soc, 1998; 46:941–946.
13.
BurackRC, GurneyJG, McDanielAM. Health status and mammography use among older women. J Gen Intern Med, 1998; 13:366–372.
14.
ChengE, MyersE, WolfL. Mobility impairments and use of preventive services in women with multiple sclerosis: Observational study. BMJ, 2001; 323:986–989.
15.
Centers for Disease Control Prevention. Use of cervical and breast cancer screening among women with and without functional limitations—United States, 1994–1995. MMWR, 1998; 47:853–856.
16.
SchoeniRF, FreedmanVA, MartinLG. Socioeconomic and demographic disparities in trends in old-age disability. TRENDS Working Paper 05-1, 2005.
17.
HewittM, DevesaSS, BreenN. Cervical cancer screening among U.S. women: Analyses of the 2000 National Health Interview Survey. Prev Med, 2004; 39:270–278.
18.
YasmeenS, RomanoPS, PettingerMet al.Incidence of cervical cytological abnormalities with aging in the Women's Health Initiative: A randomized controlled trial. Obstet Gynecol, 2006; 108:410–419.
19.
OsborneC, OstirGV, DuX, PeekMK, GoodwinJS. The influence of marital status on the stage at diagnosis, treatment, and survival of older women with breast cancer. Breast Cancer Res Treat, 2005; 93:41–47.
20.
MartinLM, WingoPA, CalleEE, HeathCWJr. Comparisons of mammography and Pap test use from the 1987 and 1992 National Health Interview Surveys: Are we closing the gaps?Am J Prev Med, 1996; 12:82–90.
21.
LurieN. Studying access to care in managed care environments. Health Serv Res, 1997; 32:691–707.
22.
CDC. Update: National breast and cervical cancer early detection program. MMWR, 1996; 45:484–487.
23.
U.S. Preventive Services Task Force. Guide to clinical preventive services, 2nd. Baltimore, MD: Williams & Wilkins, 1996.
24.
NyströmL, AnderssonI, BjurstamN, FrisellJ, NordenskjöldB, RutqvistLE. Long-term effects of mammography screening: Updated overview of the Swedish randomised trials. Lancet, 2002; 359:909–919.
25.
ClarkMA, BonacoreL, WrightW, RakowskiW. The Cancer Screening Project for Women: Experiences with cancer screening among women who partner with men and women who partner with women. Women Health, 2003; 38:19–33.
26.
ClarkMA, ArmstrongG, BonacoreL. Measuring sexual orientation and gender expression among middle-aged and older women in a cancer screening study. J Cancer Educ, 2005; 20:108–112.
27.
ClarkMA, NeighborsC, WassermanMet al.Strategies and cost of recruitment of middle-aged and older unmarried women in a cancer screening study. Cancer Epidemiol Biomarkers Prev, 2007; 16:2605–2614.
28.
ClarkMA, RogersML, ArmstrongGF, RakowskiWR, KvizFJ. Differential response effects of data collection mode in a cancer screening study of unmarried women ages 40–75 years. A randomized trial. BMC Med Res Methodol, 2008; 8:1–11.
29.
AndersonRM. Revisiting the behavioral model and access to medical care: Does it matter. J Health Soc Behav, 1995; 36:1–10.
30.
HsiaJ, KemperE, KiefeCet al.The importance of health insurance as a determinant of cancer screening: Evidence from the Women's Health Initiative. Prev Med, 2000; 31:261–270.
31.
CoughlinSS, UhlerRJ, HallHI, BrissPA. Nonadherence to breast and cervical cancer screening: What are the linkages to chronic disease risk?Prev Chronic Dis, 2004; 1:1–15.
32.
CochranSD, MaysVM, BowenDet al.Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women. Am J Public Health, 2001; 91:591–597.
33.
Rhode Island Department of Health, Cancer Control Program. Women's Cancer Screening Program. www.health.ri.gov/disease/cancer/women-screening.php.
34.
IezzoniLI, McCarthyEP, DavisRB, Harris-DavidL, O'DayB. Use of screening and preventive services among women with disabilities. Am J Med Qual, 2001; 16:135–144.
35.
BalluzL, AhluwaliaIB, MurphyW, MokdadA, GilesW, HarrisVB. Surveillance for certain health behaviors among selected local areas—United States, Behavioral Risk Factor Surveillance System, 2002. MMWR Surveill Summ, 2004; 53,SS05:1–100.
36.
U.S. Department of Health and Human Services. Healthy people 2010. 2ndUnderstanding and improving health and objectives for improving health. Washington, DC: U.S. Government Printing Office, 2000.
37.
U.S. Department of Health and Human Services. Healthy people 2000, progress review, people with disabilities. Washington, DC: U.S. Government Printing Office, 1997; 1–3.
38.
ThierryJM. Increasing breast and cervical cancer screening among women with disabilities. J Womens Health Gend Based Med, 2000; 9:9–12.
39.
IezzoniLI, McCarthyEP, DavisRB, SiebensH. Mobility impairments and use of screening and preventive services. Am J Public Health, 2000; 90:955–961.
40.
SchootmanM, JeffeDB. Identifying factors associated with disability-related differences in breast cancer. Cancer Causes Control, 2003; 14:97–107.
41.
RamirezA, FarmerGS, GrantD, PapachristouT. Disability and preventive cancer screening: Results from the 2001 California Health Interview Survey. Am J Public Health, 2005; 95:2057–2063.
42.
BechmannCRB, GittlerM, BarzanskyBM, BechmannCA. Gynecologic health care of women with disabilities. Obstet Gynecol, 1989; 74:75–79.
43.
SmeltzerSC. Preventive health screening for breast and cervical cancer and osteoporosis in women with physical disabilities. Fam Community Health, 2006; S1-29,1S:355–435.
44.
CochranSD, MaysVM. Physical health complaints among lesbians, gay men, and bisexual and homosexually experienced heterosexual individuals: Results from the California Quality of Life Survey. Am J Public Health, 2007; 97:2048–2055.
45.
SullivanG, GlassonEJ, HussainR. Breast cancer and the uptake of mammography screening services by women with intellectual disabilities. Prev Med, 2003; 37:507–512.
46.
WernekeU, HornO, Maryon-DavisA, WesselyS, DonnanS, McPhersonK. Uptake of screening for breast cancer in patients with mental health problems. J Epidemiol Community Health, 2006; 60:600–605.
47.
PeipinsL, ShapiroJ, BoboJ, BerkowitzZ. Impact of women's experiences during mammography on adherence to rescreening (United States)Cancer Causes Control, 2006; 17:439–447.
48.
LauverD, HenriquesJ, SetterstenL, BumannM. Psychosocial variables, external barriers, and stage of mammography adoption. Health Psychol, 2003; 22:649–653.
49.
LeggJS, ClementDG, WhiteKR. Are women with self-reported cognitive limitation at risk for underutilization of mammography?J Health Care Poor Underserved, 2004; 15:688–702.
50.
KlingbeilH, BaerHR, WilsonPE. Aging with a disability. Arch Phys Med Rehabil, 2004; 85:68–73.
51.
ElwoodM, McNoeB, SmithT, BandaranayakeM, DoyleTC. Once is enough—Why some women do not continue to participate in a breast cancer screening program. NZ Med J, 1998; 111:180–183.
52.
Otero-SabogalR, OwensD, CancholaJ, GoldingJM, TabnakF, FoxP. Mammography rescreening among women of diverse ethnicities: Patient, provider, and health care system factors. J Health Care Poor Underserved, 2004; 15:390–412.
53.
BordersTF, WarnerRD, SutkinG. Satisfaction with health care and cancer screening practices among women in a largely rural region of West Texas. Prev Med, 2003; 36:652–658.
54.
KagayCR, QualeC, Smith-BindmanR. Screening mammography in the American elderly. Am J Prev Med, 2006; 31:142–149.
