Breast Cancer Screening for Women with Disabilities

October is Breast Cancer Awareness Month. All women ages 50 to 74, including women with disabilities, should have a screening mammogram every two years as an important way to lower the risk of dying from breast cancer.

Breast cancer is the most common type of cancer among women in the United States, and the second leading cause of cancer-related deaths among women. Getting an X-ray of the breast every two years, called amammogram, is the best way to find breast cancer early, when it is easiest to treat.

Studies show that women with disabilities are less likely than women without disabilities to receive mammograms.1 They are also less likely to receive other routine clinical preventive services.2,3,4 Clinical preventive services are healthcare services that are delivered in clinical settings (typically a medical clinic or hospital) to prevent or identify the onset of health conditions and illnesses.

Breast Cancer Screening Guidelines

The U.S Preventive Services Task Force recommends that women between ages of 50-74 years have a screening mammogram every two years. Women between the ages of 40-49 years should talk to their doctor about when and how often they should have a screening mammogram.

Early Detection Saves Lives

Thinking "breast cancer won't happen to me" is a risk no woman should take. Regular mammogram screenings are an important way to catch breast cancer early. A mammogram, an X-ray picture of the breast, is the best way to find breast cancer early, when it is easiest to treat and before it is big enough to feel or to cause symptoms.

If breast cancer is found early, treatment can have a greater chance for success.
Many women who are diagnosed with and treated for breast cancer live long and healthy lives.

Many women, in particular those living with disabilities, still face substantial barriers to obtaining breast cancer screening. They include factors such as lack of accessible screening equipment for women with mobility limitations, limited health literacy, less self-efficacy or self-confidence in one's ability to obtain screening, lack of provider recommendation, inconvenient times to access services, and communication barriers.

Thinking "breast cancer won't happen to me" is a risk no woman should take. Regular mammogram screenings are an important way to catch breast cancer early.

Tips for Women with Disabilities

As a woman living with a disability, you may face a number of challenges that make it difficult to get a quality mammogram and clinical exam. Here are some questions you can ask when scheduling your mammogram that can help you prepare for your appointment:

How should I dress?
How do I prepare if I use a wheelchair or a scooter?
Can the machine be adjusted so I can remain seated?
How long is the appointment and can I have additional time if I need it?

Let the scheduling staff, radiology technicians, or radiologist know whether you can:

Sit upright with or without assistance.
Lift and move your arms.
Transfer from your chair/scooter.
Undress/dress without assistance.

When preparing for your mammogram, remember:

Wear a blouse that opens in the front.
Wear a bra that you can remove easily.
Do not wear deodorant or body powder.
If you have questions about the exam, related to your disability, discuss them with your primary care physician, women's health specialist, radiologist, physician's assistant, or other healthcare professional.

Most health insurance companies and Medicare and Medicaid plans cover the cost of screening mammograms. Check your insurance coverage guidelines for more details.

Are you worried about the cost or currently don't have health insurance? CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) offers free or low-cost mammograms and education about breast cancer. Find out if you qualify.

What is CDC Doing to Improve Mammography Among Women with Disabilities?

Health promotion campaigns and messages about breast cancer screening that are specifically designed to include women with disabilities may improve the number of women with disabilities who get a mammogram. CDC, in coordination with its partners, is working to improve mammography use among women with disabilities. For example:

"Every Woman Matters: Portraits of Montana Women Living with Disabilities" is a multimedia exhibit created by The Montana Disability and Health Program to highlight the importance of breast cancer screening among women with physical disabilities. Holy Rosary Healthcare in Miles City, Montana hosts the exhibit as part of its 'Pink Night Out' breast cancer awareness event. Information on where to find and plan for accessible mammography is organized in the on-line Montana Mammography Directory .
The New York Department of Health (NYSDOH) Disability and Health Program has worked closely with the NYSDOH Breast and Cervical Cancer Early Detection Program (BCCEDP) to increase providers' understanding on how to better serve women with disabilities. A continuing educationmodule was developed for providers, and a question regarding the need for an accommodation was added to the 1-800 number to access BCCEDP services.
The Oregon Office on Disability and Health has a directory to better inform Oregon women with disabilities of the accessibility/usability features of their area mammography facilities. They are working with one of their regional Americans with Disabilities (ADA) centers on promoting theiraccessibility resources for facilities interested in improving ADA accessibility.
The Association of Maternal & Child Health Programs (AMCMP)'s TOOLBOX provides links to tools that will increase knowledge about recommended services, identify service gaps, identify accessible healthcare facilities and transportation, and improve healthcare interactions between clinicians and women with disabilities.
CDC's "Breast Cancer Screening: The Right To Know" Campaign raises awareness about breast cancer among women with physical disabilities and encourages women to get screened. The campaign developed a family of health promotion materials and featured four women with physical disabilities who have survived breast cancer.

References

Courtney-Long E, Armour B, Frammartino B, & Miller J. (2011). Factors associated with self-reported mammography use for women with and women without a disability. Journal of Women’s Health, 20(9):1279-1286.
Weitz T.A., Freund, K.M., & Wright, L. (2001). Identifying and caring for underserved populations: Experience of the national centers of excellence in women's health. Journal of Women's Health & Gender-Based Medicine, 10(10): 937–952.
Wisdom, J.P., McGee, M.G., Horner-Johnson, W., Michael, Y.L., Adams, E., & Berlin, M. (2010). Health disparities between women with and without disabilities: A review of the research. Social Work in Public Health, 25(3): 368–386.
Centers for Disease Control and Prevention. Disability and Health Data System (DHDS). Accessed June 2013.