An unusual breast cancer case came to our attention in tumor board last week that was both sad and inspiring. I thought it would be worth sharing with TheONC community.
This is a 46-year-old patient, quadriplegic secondary to a tragic car accident some years ago. She is incapable of doing breast examinations among other significant activities of daily living, but her mother, as her primary care giver, palpated a breast mass during a routine bath.
An appointment was made with her primary care physician, but because she is incapable of sitting or lying flat, she was unable to complete a mammogram. An ultrasound then was used and a large breast mass was identified. This woman who had already given up so much of her independence to a crippling accident now had breast cancer. The multidisciplinary team spent a great deal of time discussing the national guidelines and how they could be applied to a disabled woman. Key questions such as:
- What are the long-term survival statistics with her other health comorbidities?
- What is the ability of a patient to undergo various follow-up imaging?
- Can the patient tolerate chemotherapy and for how long?
- What kind of surgery would be appropriate?
These are the issues that are raised often with women with disabilities. As with other disparities we see in the health field and how to address them, little is written about the disabled. They are the often forgotten group who do not get routine screening for prevention of disease and are often lost in the myriad of other medical appointments to address what is considered more urgent health care needs.
Women with disabilities often receive mammograms at lower rates than do nondisabled women, although this disparity varies by disability type and severity. Given the implementation of disability civil rights laws in the early 1990s, it is likely that little difference in actual screening has changed much from a time before that law was enacted.
From the research I was able to locate, evidence is inconsistent concerning disparities in these important cancer screening services with disability levels.1 Published studies used differing methods and definitions. More research is required to determine whether significant disparities exist in cancer screening among women with differing disability levels.1 This information is essential in order to target interventions to improve care for women with disabilities particularly in breast health screening.2, 3
In the meantime, our patient will require significant care in the continuation of her journey to wellness despite the barriers that may exist. She is among the fortunate to have a supportive family to carry her through her experience.
Has anyone worked with disabled women and found a way through the healthcare barriers?
- Welch S, Hunter-Jones J. Identifying Barriers and Facilitators to Breast Health Services among Women with Disabilities. Soc Work Public Health. 2016 Jul;31(4):255-63.
- Iezzoni LI, Kurtz SG, Rao SR. Trends in mammography over time for women with and without chronic disability. J Womens Health (Larchmt). 2015 Jul;24(7):593-601.
- Andresen EM, Peterson-Besse JJ, Krahn GL, et al. Pap, mammography, and clinical breast examination screening among women with disabilities: a systematic review. Womens Health Issues. 2013 Jul-Aug;23(4):e205-14.