Many women with advanced chronic kidney disease (CKD) may be skipping the breast and cervical cancer screening they need, even though they are at higher risk of developing cancer, according to new research.
The study with the findings, “Patterns and Predictors of Screening for Breast and Cervical Cancer in Women with CKD,” was published in the Clinical Journal of the American Society of Nephrology (CJASN).
Cancer is a significant cause of illness and death in CKD patients, who show a cancer prevalence that is twice as high as the general population and a poorer prognosis. The increased risk of cancer seems to be specific for urinary tract, digestive, breast, and viral-related cancer, and patients should receive routine screening for these cancers.
To examine the patterns of breast and cervical cancer screening in women with CKD, Germaine Wong, PhD, from the University of Sydney in Australia, and colleagues at the University of Ontario, Canada, used clinical information included in the administrative health data from Ontario, Canada, from 2002 to 2013.
A total of 141,326 women were included in the breast screening cohort, while 324,548 women were included in the cervical cancer screening cohort.
The researchers found that older age, higher co-morbidity, and lower income were all associated with lower rates of screening. In addition, patients with advanced CKD (stages 4 and 5) requiring dialysis were less likely to undergo breast and cervical cancer screening than women with early stage kidney disease (stages 3a and 3b).
Indeed, while the two-year cumulative incidence of breast cancer screening was 61 percent among women without kidney disease, those with stage 3 CKD had a cumulative incidence of 54 percent, patients with stage 4 and 5 CKD had an incidence of breast cancer screening of 37 percent, and those with kidney failure and on dialysis had a two-year cumulative incidence of breast cancer screening of 26 percent.
Similar results were obtained when the researchers looked at the three-year cumulative incidence for cervical cancer screening.
“These results reflect the inherent healthcare priorities of dialysis patients: older women on dialysis may not have the capacity to deal with the complexity of dialysis management and may have potentially neglected less imminent issues such as preventive healthcare and early cancer detection,” Wong said in a news release. “Given that cancer screening has the potential to improve cancer outcomes, targeted strategies to inform shared decision making in screening is critical.”
Deidra Crews, MD, ScM, and Waseem Khaliq, MBBS, MPH, (Johns Hopkins University School of Medicine) suggest that nephrologists, general practitioners and healthcare providers should work together to improve the rates of cancer screening among CKD patients.
“Nephrologists may forge long-term trusting relationships with kidney patients that will afford them the greatest opportunity to engage in shared decision-making together and select the cancer screening plan that is most appropriate for the patient’s individual health status and personal priorities,” they wrote in an accompanying editorial.