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Am Fam Physician. 1998;57(7):1674

Anecdotal evidence suggests that women with physical disabilities face barriers to preventive health care measures such as breast and cervical cancer screening. Nosek and Howland evaluated the rate of mammography and cervical cancer screening among women with physical disabilities in a case-comparison study that was part of the National Study of Women with Physical Disabilities.

A total of 946 women completed a 311-item questionnaire eliciting information about reproductive health. Of this group, 504 women had physical disabilities and 442 women did not. The women without disabilities were used as the comparison group. Of 450 women with disabilities who were questioned about the frequency of pelvic examinations, 67.1 percent reported receiving a pelvic examination regularly. In comparison, 72.8 percent of the women without disabilities reported having regular pelvic examinations. The reasons the physically disabled women gave for not having regular pelvic examinations included difficulty getting onto an examination table (37.2 percent), lack of time (31.1 percent) and inability to find a doctor who suits them (29.1 percent).

The question about mammography was answered by 320 women (210 with disabilities and 110 without disabilities). No significant difference between the two groups was noted in the rate of screening mammography within the previous two years; 55.2 percent of the women with disabilities had had a mammographic examination, compared with 50.0 percent of those without disabilities. The most common reasons given by the women with physical disabilities who had not had mammograms were inability to get into the position required for mammography (34.1 percent), not being informed by their physician of the need for mammography (25.0 percent) and the belief that they were at very low risk of breast cancer (23.5 percent).

The authors conclude that women with physical disabilities, especially those with more severe functional limitations, are less likely than women without disabilities to receive regular pelvic examinations. Data from the study suggest that women with mild or moderate functional impairment are not unlike women in general with regard to cervical cancer screening. The authors note that the results of the survey must be interpreted cautiously. The women who participated in the study had a relatively high level of education and moderate income and lived in an urban area. In addition, the eligibility criteria excluded women over age 65, a group that may be more noncompliant with pelvic examinations.

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Copyright © 1998 by the American Academy of Family Physicians.

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