Chronic Medical Illness as a Risk Factor for Poor Mammography Screening Adherence

The aim of this study was to determine the association between the presence of chronic medical disease and mammography screening adherence. We performed a retrospective study on women between the ages of 50 and 64 who received screening mammography in 2005 and had at least 8 years of follow-up. Demographic and clinical information was obtained from our centralized patient data registry. Women diagnosed with one or more of the following diseases for at least 3 months before their index mammogram were considered to have a chronic disease, including atrial fibrillation, congestive heart failure, Chronic Obstructive Pulmonary Disease (COPD), diabetes mellitus type II, heart disease, and/or peripheral vascular disease. Generalized estimating equations were used to evaluate for correlated observations. Multivariable regression analyses were used to evaluate the effects of selected chronic medical diseases on longitudinal engagement with routine mammography. Of 9575 women identified, 1669 (17.7%) had one or more of the selected chronic medical diseases. The presence of one or more of these diseases was associated with reduced mammography screening (-0.29; confidence interval [CI] = -0.36 to -0.14; p < 0.01) compared with women without these diseases over the study period. Within this group, the presence of congestive heart failure (-0.88; CI = -0.84 to -0.45; p ≤ 0.01), COPD (-0.39; CI = -0.57 to -0.21; p ≤ 0.01), or diabetes mellitus type II (-0.37; CI = -0.57 to -0.17; p ≤ 0.01) was individually associated with reduced screening compared with women without the respective disease. Compared with women without chronic medical disease, women with multiple chronic medical diseases (-0.62; CI = -0.93 to -0.30; p ≤ 0.01) were significantly (p ≤ 0.05) less likely to receive routine screening, while no significant difference was seen in women with only one chronic medical disease (-0.18; CI = -0.39 to -0.02; p ≤ 0.08). Despite experiencing longer life expectancies, women with specific chronic diseases may experience additional barriers to uptake of mammography screening, which is likely compounded by the comorbidity burden of being simultaneously treated for multiple chronic conditions. Increased health care interactions seen in this group may represent missed opportunities to improve screening adherence.