title: Cervical and breast cancer screening participation for women with chronic conditions in France: results from a national health survey.
abstract: BACKGROUND
  Comorbidity at the time of diagnosis is an independent prognostic factor for survival among women suffering from cervical or breast cancer. Although cancer screening practices have proven their efficacy for mortality reduction, little is known about adherence to screening recommendations for women suffering from chronic conditions. We investigated the association between eleven chronic conditions and adherence to cervical and breast cancer screening recommendations in France.
  
  
  METHODS
  Using data from a cross-sectional national health survey conducted in 2008, we analyzed screening participation taking into account self-reported: inflammatory systemic disease, cancer, cardiovascular disease, chronic respiratory disease, depression, diabetes, dyslipidemia, hypertension, obesity, osteoarthritis and thyroid disorders. We first computed age-standardized screening rates among women who reported each condition. We then estimated the effect of having reported each condition on adherence to screening recommendations in logistic regression models, with adjustment for sociodemographic characteristics, socioeconomic position, health behaviours, healthcare access and healthcare use. Finally, we investigated the association between chronic conditions and opportunistic versus organized breast cancer screening using multinomial logistic regression.
  
  
  RESULTS
  The analyses were conducted among 4226 women for cervical cancer screening and 2056 women for breast cancer screening. Most conditions studied were not associated with screening participation. Adherence to cervical cancer screening recommendations was higher for cancer survivors (OR = 1.73 [0.98-3.05]) and lower for obese women (OR = 0.73 [0.57-0.93]), when accounting for our complete range of screening determinants. Women reporting chronic respiratory disease or diabetes participated less in cervical cancer screening, except when adjusting for socioeconomic characteristics. Adherence to breast cancer screening recommendations was lower for obese women and women reporting diabetes, even after accounting for our complete range of screening determinants (OR = 0.71 [0.52-0.96] and OR = 0.55 [0.36-0.83] respectively). The lower breast cancer screening participation for obese women was more pronounced for opportunistic than for organized screening.
  
  
  CONCLUSIONS
  We identified conditions associated with participation in cervical and breast cancer screening, even when accounting for major determinants of cancer screening. Obese women participated less in cervical cancer screening. Obese women and women with diabetes participated less in mammographic screening and organized breast cancer screening seemed to insufficiently address barriers to participation.
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France. panayotis.constantinou@inserm.fr.|Université Paris-Saclay, Université Paris-Sud, UVSQ, INSERM, Centre for research in Epidemiology and Population Health (CESP), Villejuif, France. panayotis.constantinou@inserm.fr.
authors.forename: Panayotis
authors.initials: P
authors.lastname: Constantinou
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dray-Spira
authors.affiliation: Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
authors.forename: Gwenn
authors.initials: G
authors.lastname: Menvielle
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D002908:Chronic Disease / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D065006:Papanicolaou Test; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology
keywords: Breast neoplasms; Cancer screening; Chronic disease; Comorbidity; France; Uterine cervical neoplasms