Dominika Bhatia1, Rinku Sutradhar2,3, Peter C Austin2,3,4, Vasily Giannakeas3,5, Liisa Jaakkimainen2,3,4,6, Lawrence F Paszat2,3,4, Lorraine L Lipscombe2,3,5,7. 1. Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. dominika.bhatia@mail.utoronto.ca. 2. Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. 3. ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. 4. Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. 5. Women's College Hospital, Women's College Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada. 6. Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada. 7. Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ONs, M5S 1A8, Canada.
Abstract
PURPOSE: Diabetes is associated with poorer cancer outcomes. Screening for breast and cervical cancer is recommended by clinical guidelines; however, utilization of these tests in people with diabetes has been unclear due to methodological limitations in the evidence base. We used administrative data to determine the association between diabetes and the rates of becoming up-to-date with periodic breast and cervical cancer screening over a 20-year period. METHODS: Healthcare databases from Ontario, Canada, were linked to assemble two population-based cohorts of 50-70 and 21-70 year-olds between 1994 and 2011, eligible for breast and cervical cancer screening, respectively. Using age as the time scale, multivariable recurrent events models were implemented to examine the association between the presence of diabetes and the rates of becoming up-to-date with the recommended cancer screenings. RESULTS: In each of the breast and cervical cancer screening cohorts, there were, respectively, 1,516,302 (16% had diabetes at baseline) and 4,751,220 (9.5% had diabetes at baseline) screen-eligible women. In multivariable models, prevalent diabetes (duration ≥ 2 years) was associated with lower rates of becoming up-to-date with cervical (hazard ratio, HR 0.85, 95% confidence interval, CI 0.84-0.85) and breast (HR 0.94, CI 0.93-0.94) cancer screening, compared to no diabetes. CONCLUSIONS: Having diabetes is associated with decreased rates of becoming up-to-date with two recommended periodic cancer screenings, with a bigger reduction in the rates of becoming up-to-date with cervical cancer screening. Greater attention to cervical cancer preventive services is needed in women with diabetes.
PURPOSE: Diabetes is associated with poorer cancer outcomes. Screening for breast and cervical cancer is recommended by clinical guidelines; however, utilization of these tests in people with diabetes has been unclear due to methodological limitations in the evidence base. We used administrative data to determine the association between diabetes and the rates of becoming up-to-date with periodic breast and cervical cancer screening over a 20-year period. METHODS: Healthcare databases from Ontario, Canada, were linked to assemble two population-based cohorts of 50-70 and 21-70 year-olds between 1994 and 2011, eligible for breast and cervical cancer screening, respectively. Using age as the time scale, multivariable recurrent events models were implemented to examine the association between the presence of diabetes and the rates of becoming up-to-date with the recommended cancer screenings. RESULTS: In each of the breast and cervical cancer screening cohorts, there were, respectively, 1,516,302 (16% had diabetes at baseline) and 4,751,220 (9.5% had diabetes at baseline) screen-eligible women. In multivariable models, prevalent diabetes (duration ≥ 2 years) was associated with lower rates of becoming up-to-date with cervical (hazard ratio, HR 0.85, 95% confidence interval, CI 0.84-0.85) and breast (HR 0.94, CI 0.93-0.94) cancer screening, compared to no diabetes. CONCLUSIONS: Having diabetes is associated with decreased rates of becoming up-to-date with two recommended periodic cancer screenings, with a bigger reduction in the rates of becoming up-to-date with cervical cancer screening. Greater attention to cervical cancer preventive services is needed in women with diabetes.
Authors: Lonneke V van de Poll-Franse; Saskia Houterman; Maryska L G Janssen-Heijnen; Marcus W Dercksen; Jan Willem W Coebergh; Harm R Haak Journal: Int J Cancer Date: 2007-05-01 Impact factor: 7.396
Authors: Lorraine L Lipscombe; Hadas D Fischer; Peter C Austin; Longdi Fu; R Liisa Jaakkimainen; Ophira Ginsburg; Paula A Rochon; Steven Narod; Lawrence Paszat Journal: Breast Cancer Res Treat Date: 2015-03-17 Impact factor: 4.872
Authors: Edward Giovannucci; David M Harlan; Michael C Archer; Richard M Bergenstal; Susan M Gapstur; Laurel A Habel; Michael Pollak; Judith G Regensteiner; Douglas Yee Journal: Diabetes Care Date: 2010-07 Impact factor: 19.112
Authors: Erin Worndl; Kinwah Fung; Hadas D Fischer; Peter C Austin; Monika K Krzyzanowska; Lorraine L Lipscombe Journal: JNCI Cancer Spectr Date: 2018-05-11