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Diabetes may distract women from cancer screenings

(Reuters Health) – The burdens of managing a chronic illness such as diabetes may lead women to skip recommended cancer screenings, researchers say.

An analysis of data from studies over two decades finds that women with diabetes are less likely than those without the disease to get screened for cervical, breast and colorectal cancers.

“We know people with diabetes have a small but significantly increased risk for certain types of cancer. We wanted to find out if lower cancer screening is contributing to these differences, ”said senior researcher Dr. Lorraine Lipscombe, an endocrinologist at Women's College Hospital and an associate professor of medicine at the University of Toronto.

"And, if there is a higher risk of cancer, we want to make sure we catch the cancers early," Lipscombe told Reuters Health in a phone interview.

The authors searched for studies performed between 1997 and 2018 on recommended screening rates in adults with diabetes: mammography for breast cancer and Papanicolaou (Pap) tests for cervical cancer in women, and fecal blood or colonoscopy tests for colorectal cancer in women and men. .

Of the 37 studies included in the analysis, 21 were from the U.S., three were from Canada and the rest were from Europe, the Middle East and Asia. Study groups ranged in size from 129 to 732,687 people.

Overall in studies, women with diabetes were 24% less likely than women without diabetes to get cervical cancer screening and 17% less likely to get breast cancer screening, researchers reported in Diabetologia.

When the study team looked at colorectal screening rates, women with diabetes were 14% less likely to be screened without the disease, while men with and without diabetes had similar screening rates.

Diabetes has a high burden of care, Lipscombe said.

"The complexity and time taken to manage diabetes can mean routine preventive services such as cancer screening may be forgotten or neglected, by both patients and providers."

It is not clear why colon cancer screening rates diverged only for women, she noted. "We wonder if there is a perception that colorectal cancer is more common in men than women."

"Patients with diabetes get screened for the development of traditional diabetes complications like retinopathy, nephropathy and neuropathy, and blood pressure, lipid monitoring and treatment," noted Dr. Emily J. Gallagher, an assistant professor of endocrinology, diabetes and bone disease at the Icahn School of Medicine at Mount Sinai in New York City, who is involved in the study.

The focus on managing diabetes may be lower priority in cancer, said Gallagher, whose practice focuses on diabetes and endocrine conditions in cancer patients.

She agrees with researchers that better awareness of the importance of cancer screenings among diabetes patients and their healthcare providers is needed.

"We know the more chronic a person has, the less likely they are to see their primary care provider, but the latter must remain part of the team," Lipscombe said.

The good news, she added, is with early cancer screening, "the prognosis is as good for diabetics as it is for people without the disease."

SOURCE: Diabetologia, online October 24, 2019.

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