Pap, Mammography, and Clinical Breast Examination Screening Among Women with Disabilities: A Systematic Review



      Research has found some disparities between U.S. women with and without disabilities in receiving clinical preventive services. Substantial differences may also exist within the population of women with disabilities. The current study examined published research on Pap smears, mammography, and clinical breast examinations across disability severity levels among women with disabilities.


      Informed by an expert panel, we followed guidelines for systematic literature reviews and searched MEDLINE, PsycINFO, and Cinahl databases. We also reviewed in-depth four disability- or preventive service-relevant journals. Two reviewers independently extracted data from all selected articles.


      Five of 74 reviewed publications of met all our inclusion criteria and all five reported data on Pap smears, mammography, and clinical breast examination. Articles classified disability severity groups by functional and/or activity levels. Associations between disability severity and Pap smear use were inconsistent across the publications. Mammography screening fell as disability level increased according to three of the five studies. Results demonstrated modestly lower screening, but also were inconsistent for clinical breast examinations across studies.


      Evidence is inconsistent concerning disparities in these important cancer screening services with increasing disability levels. Published studies used differing methods and definitions, adding to concerns about the evidence for screening disparities rising along with increasing disability. More focused research is required to determine whether significant disparities exist in cancer screening among women with differing disability levels. This information is essential for national and local public health and health care organizations to target interventions to improve care for women with disabilities.
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      Elena Andresen is Professor of Epidemiology, Chief of the Disability and Health Research Group, and Director of the Oregon Office on Disability and Health at Oregon Health & Science University in Portland, Oregon.


      Jana Peterson-Besse is Assistant Professor of Public Health at Pacific University in Forest Grove, Oregon.


      Gloria Krahn is division director for the Division on Human Development and Disability at the Centers for Disease Control and Prevention in Atlanta, Georgia. She was formerly professor of public health and preventive medicine at Oregon Health & Science University in Portland, Oregon.


      Emily Walsh is a research associate with the Kaiser Permanente Research Affiliates Evidence-based Practice Center in Portland, Oregon. She was a research associate at Oregon Health & Science University at the time this work was completed.


      Willi Horner-Johnson is a Research Assistant Professor of Public Health and Preventive Medicine at Oregon Health & Science University in Portland, Oregon. Her research focuses on disparities in health and access to healthcare for adults with disabilities.


      Lisa Iezzoni is Professor of Medicine at Harvard Medical School and Director of the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston. Dr. Iezzoni is a member of the Institute of Medicine in the National Academy of Sciences.