Disability and Rehabilitation Research Project: Health and Health Care
Disparities Among Individuals with Disabilities
Research Brief on Women’s Health
November 2013
A Publication of the Institute on Disability at the University of New Hampshire
Written by:
Michelle L. Stransky, Ph.D.
The Disability and
Rehabilitation Research
Project: Health and
Health Care Disparities
Among Individuals with
Disabilities project is a fiveyear partnership between
the University of New
Hampshire Institute on
Disability and the National
Institute on Disability and
Rehabilitation Research,
U.S. Department of
Education.
The Institute on Disability
at the University of New
Hampshire was established
in 1987 to provide a
university-based focus
for the improvement of
knowledge, policies, and
practices related to the lives
of persons with disabilities
and their families.
Questions/Comments:
603.862.4320
dph.iod@unh.edu
www.iod.unh.edu/dph
Available in alternative
formats upon request.
A Summary of “Pap, mammography, and clinical breast examination screening
among women with disabilities: A systematic review” by Elena M. Andresen, Jana
J. Peterson-Besse, Gloria L. Krahn, Emily S. Walsh, Willi Horner-Johnson, and Lisa
I. Iezzoni. (2013). Published in Women’s Health Issues, 23(4), e205-e214.
Introduction
The U.S. Preventive Services Task Force (USPSTF) has established breast and cervical cancer
screening guidelines for all women, regardless of the presence of a disability.1,2 In 2002, screening mammography was recommended at least once every two years for women over the age
of 39, regardless of clinical breast examinations; in 2009, the recommendation was updated,
reflecting new age guidelines. As of 2009, mammography screening was recommended at least
every two years for women ages 50-74, with individual factors guiding screening decisions prior
to age 50. In 2003, cervical cancer screening was recommended for sexually active women with
cervixes.
Previous studies have found that women with disabilities are less likely to receive breast and
cervical cancer screenings than are women without disabilities.1,3 However, there may be substantial differences in rates of screening within the population of women with disabilities due to
the severity of the disability.
Overview
Andresen et al. (2013)1 summarizes the results of a systematic scoping review of previously
published peer-reviewed literature. A systematic scoping review utilizes rigorous scientific
methods to locate and review previously published research.1,4 The five studies included in
Andresen et al.’s (2013)1 analysis are: Cheng et al. (2001),5 Chevarley et al. (2006),6 Diab and
Johnston (2004),7 Iezzoni et al. (2000),8 and Iezzoni et al. (2001).9 Detailed information on the
literature search and methodology can be found in the complete article.1
Summary of Findings
Andresen et al. (2013)1 found that:
There is some evidence that women with more severe disabilities had lower rates of mammography screening and clinical breast exams than women with less severe disabilities.1
However, it is not clear whether screening rates are lower among women whose disabilities are
rated more severely or if women with the most severe disabilities have lower screening rates than
all other women with disabilities. There was no clear relationship between Pap screening and
disability severity.
Each of the studies examined used different definitions of disability and disability severity.1 The definitions of disability and disability severity reflected the purpose of each study. For
example, disability severity was defined as ambulatory assistance needs,1,5 functional limitations,1,6 activity limitations,1,7 and mobility problems.1,8,9 The different definitions led to different conclusions about the impact of disability and disability severity on receipt of breast and
cervical cancer screening.
Summary of Implications
Additional research on access to breast and cervical cancer screening among women with
disabilities is needed.1 People with disabilities should be considered a subgroup of the popula-
tion with unequal access to health and health care resources. More research is needed to develop a clear understanding of
this topic to improve targeted efforts to improve cancer screening.
Future research should use standardized definitions of disability and disability severity.1 Recently established standards for identifying disability1,10 should assist in the development of research whose findings can be readily compared.
Researchers should distinguish types of disabilities and include measures of disability severity in their research,1,11 despite the fact that the questions adopted for identifying disability do not include questions addressing disability severity.
Future research should examine the impact that social factors have on health and health care outcomes among people with disabilities.1 Social factors – such as age, education, and rural residence – can facilitate or impede access to care;
yet, the impact of these factors is often relegated to statistical analyses. Researchers should make an effort to include a
discussion of the impact of social factors on the health and health care outcomes being studied.
Article Information
This brief contains a brief description of the background, key findings, and implications of a published, peer-reviewed
journal article. For more information on this research, please see the complete article1: Andresen, E.M., Peterson-Besse,
J.J., Krahn, G.L., Walsh, E.S., Horner-Johnson ,W., & Iezzoni, L.I. (2013). Pap, mammography, and clinical breast examination screening among women with disabilities: A systematic review. Women’s Health Issues, 23(4), e205-e214. Available at: http://www.whijournal.com/article/S1049-3867%2813%2900034-0/abstract?source=aemf. Andresen et al.’s
research was supported by National Institute on Disability and Rehabilitation Research/DOE grant #H133A080031.
Endnotes
1 Andresen, E.M., Peterson-Besse, J.J., Krahn, G.L., Walsh, E.S., Horner-Johnson ,W., & Iezzoni, L.I. (2013). Pap, mammography,
and clinical breast examination screening among women with disabilities: A systematic review. Women’s Health Issues, 23(4), e205e214.
2 See, for example, U.S. Preventive Services Task Force (USPSTF). (2010). Recommendations. Retrieved May 21, 2012, from www.
uspreventiveservicestaskforce.org/recommendations.htm; U.S. Preventive Services Task Force (USPSTF). (2009). The guide to
clinical preventive services. Rockville, MD: Agency for Healthcare Research and Quality; U.S. Preventative Services Task Force
(USPSTF). (2002). Screening for breast cancer: Recommendations and rationale. Annals of Internal Medicine, 137(5 Part 1),
344–346; U.S. Preventive Services Task Force (USPSTF). (2012). Screening for cervical cancer: U.S. preventive services task force
recommendation statement. Retrieved September 11, 2012, from www.uspreventiveservicestaskforce.org/uspstf/uspscerv.htm.
3 See, for example, 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; Havercamp, S. M.,
Scandlin, D., & Roth, M. (2004). Health disparities among adults with developmental disabilities, adults with other disabilities, and
adults not reporting disability in North Carolina. Public Health Reports, 119(4), 418–426; Nosek, M. A., & Gill, C. J. (1998). Use
of cervical and breast cancer screening among women with and without functional limitations: United States, 1994-1995. MMWR
- Morbidity & Mortality Weekly Report, 47(40), 853–856; Wei, W., Findley, P. A., & Sambamoorthi, U. (2006). Disability and receipt
of clinical preventive services among women. Women’s Health Issues, 16(6), 286–296; 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.
4 See, for example, Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal
of Social Research Methodology, 8(1), 19–32; Petticrew, M., & Roberts, H. (2006). Systematic reviews in the social sciences: A practical
guide. Malden, MA: Blackwell.
5 Cheng, E., Meyers, L., Wolf, S., Shatin, D., Cui, X.P., Ellison, G., Belin, T., & Vickrey, B. (2001). Mobility impairments and use of
preventive services in women with multiple sclerosis: Observational study. BMJ, 323, 968-969.
6 Chevarley, F.M., Thierry, J.M., Gill, C.J., Ryerson, A.B., & Nosek, M.A. (2006). Health, preventive health care, and health care access among women with disabilities in the 1994-1995 National Health Interview Survey, Supplement on Disability. Women’s Health
Issues, 16(6), 297–312.
7 Diab, M.E., & Johnston, M.V. (2004). Relationships between level of disability and receipt of preventive health services. Archives of
Physical Medicine and Rehabilitation, 85(5), 749–757.
8 Iezzoni, L.I., McCarthy, E.P., Davis, R.B., & Siebens, H. (2000). Mobility impairments and use of screening and preventive services. American Journal of Public Health, 90(6), 955–961.
9 Iezzoni, L.I., McCarthy, E.P., Davis, R.B., Harris-David, L., & O’Day, B. (2001). Use of screening and preventive services among
women with disabilities. American Journal of Medical Quality, 16(4), 135–144.
10 See, for example, U.S. Department of Health and Human Services, Office of Minority Health. (2011). Final data collection standards for race, ethnicity, primary language, sex, and disability status required by section 4302 of the Affordable Care Act. Rockville,
MD: Author. Retrieved September 5, 2012, from minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=208; Madans, J.,
Loeb, M., & Altman, B. (2011). Measuring disability and monitoring the UN convention on the rights of persons with disabilities:
The work of the Washington Group on Disability Statistics. BMC Public Health, 11(Suppl. 4), S4.
11 Altman, B., & Bernstein, A. (2008). Disability and health in the United States, 2001–2005. DHHS publication no. (PHS) 2008–
1035. Hyattsville, MD: National Center for Health Statistics.