title: Adherence to breast and cervical cancer screening in Spanish women with diabetes: associated factors and trend between 2006 and 2010.
abstract: OBJECTIVE
  This study aimed to assess the adherence to breast and cervical cancer screening of women with diabetes mellitus (DM), and the associated factors and trend of use over time of these preventative services between 2006 and 2010 in Spain.
  
  
  METHODS
  The study used data from a population of women aged greater or equal to 18 years (n=11,957) who participated in the European Health Interview Survey in Spain (EHISS, 2009). Diabetes status was self-reported and included those with type 2 DM. Adherence to screening for cancer prevention was assessed by asking women aged greater or equel to 40 years whether they had undergone mammography and a Papanicolaou (Pap) cervical smear (in those aged 18-69 years) within the previous 2 and 3 years, respectively. Independent variables included sociodemographic and health-related characteristics. Also, the age-standardized prevalences of mammography and Pap smear uptake were compared in women with diabetes between 2006 and 2010.
  
  
  RESULTS
  Among the diabetic women, 37.9% underwent mammography and 49.1% had a Pap smear vs 53.8% and 64%, respectively, in women without diabetes, with corresponding adjusted odds ratios of 0.81 (95% CI: 0.68-0.97) and 0.74 (95% CI: 0.60-0.91). Among diabetic women, attending more "physician visits" was a positive predictor of having both screening tests. Also, a higher monthly income level was associated with mammography uptake, and a higher educational level with Pap smear uptake. There was also a significant decrease in mammography screening uptake between 2006 and 2010 compared with a stable rate of uptake of cervical cancer screening.
  
  
  CONCLUSIONS
  Spanish women with diabetes consistently underuse breast and cervical cancer screening tests compared with non-diabetic women. The decline in mammography uptake rates needs to be carefully monitored and may even call for intervention.
authors.affiliation: Preventive Medicine Unit, Rey Juan Carlos University, Madrid, Spain. marhuedo@hotmail.com
authors.forename: M A
authors.initials: MA
authors.lastname: Martinez-Huedo
authors.forename: A
authors.initials: A
authors.lastname: Lopez de Andres
authors.forename: V
authors.initials: V
authors.lastname: Hernandez-Barrera
authors.forename: P
authors.initials: P
authors.lastname: Carrasco-Garrido
authors.forename: D
authors.initials: D
authors.lastname: Martinez Hernandez
authors.forename: R
authors.initials: R
authors.lastname: Jiménez-Garcia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D065006:Papanicolaou Test; D010349:Patient Compliance; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D016387:Women's Health; D055815:Young Adult