Breast cancer screening among women with comorbidities: A cross-sectional study of disparities

Research output: Contribution to conferencePosterpeer-review


Background: Breast cancer (BRCA) is the leading cause of cancer death among women worldwide. Fortunately, frequent mammography among 50 to 69 year-old women decreases BRCA mortality between 20% to 35%; however, comorbidities, existing in the presence of a BRCA diagnosis, significantly lower rates of survival. Given the importance of BRCA screening, our primary objective was to determine if screening rates differed among individuals with and without diagnoses of any of the following: diabetes, hypertension (HTN), cardiovascular disease (CVD), skin cancer, chronic obstructive pulmonary disease (COPD), arthritis, kidney disease, or depression compared to healthy patients. Secondarily, we will assess whether multiple comorbidities have an increasing effect on BRCA screening rates.

Methods: Using the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) datasets we constructed multivariate logistic regression models to determine the adjusted risk ratios (ARR) of persons receiving BRCA screening with and without comorbidities. To assess our secondary objective, we constructed a regression model to determine the likelihood of individuals with multiple comorbidities (1, 2-4, 5+) having a breast cancer screening. Regression models were adjusted for race, age, healthcare coverage, and education level. A post hoc regression model was conducted to assess the impact of health insurance on breast cancer screening, accounting for all co-occurring diagnoses and sociodemographic variables.

Results: Our models showed statistically significant associations among BRCA screening and all chronic conditions except for kidney disease. Individuals who were obese (ARR: 1.03, 95%CI:1.01-1.04), had diabetes (ARR: 1.02, 95%CI: 1.00-1.04), HTN (ARR: 1.11, 95%CI: 1.03-1.19), a skin cancer diagnosis (ARR: 1.05, 95%CI: 1.03-1.07), or arthritis (ARR: 1.05, 95%CI: 1.03-1.07) were more likely to have completed a BRCA screening, while individuals with CVD (ARR: 0.89, 95%CI: 0.83-0.96), COPD (ARR: 0.95, 95%CI: 0.92- 0.97), and depression (ARR: 0.98, 95%CI: 0.96-0.99) were less likely to be screened, controlling for age, race, healthcare coverage, and education. The post hoc analysis showed that the odds of women without healthcare coverage were 62% less likely (OR: .38; 95%CI: 0.34-0.43) to have a breast cancer screening than women with coverage, and also indicated that the odds of having a screening increased with increased education.

Conclusion: We found that people with co-occurring diagnoses including obesity, diabetes, HTN, skin cancer, and arthritis completed BRCA screening more often than those with no comorbidities. Conversely, individuals living with CVD, COPD, and depression were less likely to receive potentially life-saving BRCA screening. Our findings are supported by previous studies that BRCA screening rates are inversely proportional to healthcare coverage and educational attainment. The critical nature of BRCA screening’s effectiveness in reducing mortality through early detection highlights the need for greater multidisciplinary care integration to increase preventive health measures in the primary care setting where most chronic conditions are managed, including CVD and depression.
Original languageAmerican English
StatePublished - 22 Feb 2021
EventOklahoma State University Center for Health Sciences Research Days 2021: Poster presentation - Oklahoma State University Center for Health Sciences Campus, Tulsa, United States
Duration: 22 Feb 202126 Feb 2021


ConferenceOklahoma State University Center for Health Sciences Research Days 2021
Country/TerritoryUnited States


  • Breast Cancer
  • Health disparities
  • Comorbidities
  • Behavior Risk Factor Surveillance System
  • Multidisciplinary Care Coordination


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