Diabetes and Mammograms


By: Amy Mercer

Many women with diabetes feel overwhelmed by the responsibilities of family, work, and personal health. Balancing the minutiae of everyday life with the nonstop demands of blood glucose monitoring, exercise, and thoughtful meal planning takes time and effort. So it comes as no surprise that many women with diabetes put off talking to their doctors about breast cancer screening.

Recent studies have revealed that women with diabetes are less likely to undergo screening for breast cancer. Researchers suspect that because of the complexity involved in diabetes care, routine preventive care such as cancer screening is often neglected. (1)
Claire Blume, a CDE with type 1 diabetes, says, “From personal experience, it is not always at the top of my list because I see the endocrinologist so frequently.”

An estimated 40,000 people die annually as a result of breast cancer. Breast cancer ranks second as a cause of cancer death in women, after lung cancer. Mammography can often detect breast cancer at an early stage, when treatment is more effective. On average, a mammogram will detect about 80 to ­90 percent of breast cancers in women without symptoms. (2)  Breast cancer screening may be especially important in women with type 2 diabetes because evidence suggests that diabetes increases the risk of breast cancer and breast cancer mortality.

Despite recommendations, however, many women with diabetes are not being screened for breast cancer. The reasons are varied.  Many of the women are less educated, are living in impoverished or rural areas, or don’t have a regular care provider.  Socioeconomic and cultural barriers may render diabetic patients less likely to advocate for preventive care. (3)

In addition, advances in diabetes management have placed greater demands on endocrinologists, diabetes educators, and primary care providers. This fact, combined with limited office visit times, may restrict the amount of information a doctor can share. Dr. Liz Stephens says, “There is just a lot to cover in a 15- or 20-minute follow-up visit. As an endocrinologist, I certainly forget to remind my female patients to get their mammograms.”

The good news is that studies have found that simple, inexpensive interventions such as letters to patients, mailed educational materials, and telephone calls significantly improve mammography screening uptake rates. These strategies could decrease the dependence on increasingly time-constrained primary care physicians and may be particularly useful for women with less education. (3)

1) Reduced Screening Mammography Among Women With Diabetes
Lorraine L. Lipscombe, MD; Janet E. Hux, MD, MSc; Gillian L. Booth, MD, MSc

2) American Cancer Society http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/index

3) Screening Mammogram Utilization in Women With Diabetes
Thomas J. Beckman, MD, Robert M. Cuddihy, MD, Sidna M. Scheitel, MD, MPH,
James M. Naessens, MPH, Jill M. Killian, BS and V. Shane Pankratz, PHD
doi: 10.2337/diacare.24.12.2049, Diabetes Care December 2001 vol. 24 no. 12 2049-2053



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