Breast and Cervical Cancer Screening Rates Low Among Women With Advanced Kidney Disease

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Highlights

• Breast and cervical cancer are the leading cause of death in women.
• The prevalence of cancer in women with chronic kidney disease (CKD) is two fold higher compared to women in general population.
• But most women with advanced CKD do not receive screening for breast and cervical cancer.

Women with advanced kidney disease do not receive the recommended breast or cervical cancer screening. Such women face a higher risk of developing cancer compared to women in general population. The prevalence of cancer is two fold higher in women with advanced kidney disease, finds a new study.

The increased risk appears to be specific for cancers of

• Urinary tract
• Viral-related (human-papillomavirus)
• Digestive tract
• Breast

Chronic Kidney Disease

Chronic kidney disease (CKD) is a long-term disease of the kidneys in which the ability of the kidneys to function normally is gradually lost. Most of the time, CKD is caused by chronic conditions like diabetes and high blood pressure that affects the functioning of kidneys over time.

‘Cancer screening has the potential to improve cancer outcomes. Therefore a better understanding of patient and health professional preferences toward cancer screening among women with chronic kidney disease is necessary.’

Progression of this condition leads to kidney failure, which requires dialysis or kidney transplant for sustenance of life.

About 26 million adults across the U.S have CKD and millions are at the risk of developing the condition. In women, breast cancer is the most common consequence of CKD followed by cancers of the lung and urinary tract.

Kidney transplant increases the risk of cancer by three to four-fold. Dialysis increases the risk of cervical, kidney, bladder, stomach, thyroid and lung cancers. After dialysis, cancer risk increases by 10% to 80%.

Breast and cervical cancer screening is especially important in women with chronic kidney disease (CKD) because cancer is a significant cause of illness and death in such patients.

Examining Screening Pattern

The research team led by Germaine Wong, PhD, (The University of Sydney, in Australia), Jade Hayward, and Danielle Nash, PhD (Institute for Clinical Evaluative Sciences, ICES Western facility, in Ontario, Canada) examined the patterns of breast and cervical cancer screening in women with CKD, based on the stage and age of the kidney disease and assessed the predictors of screening.

In the retrospective study, researchers gathered data from 2002 to 2013 from the Ontario, Canada administrative healthcare databases.

The study included:

• 141,326 women for breast cancer screening
• 324,548 women for cervical cancer screening

Findings

Screening rates for breast and cervical cancer were low among

• Older women
• Women with advanced stage kidney disease that required dialysis
• Women with higher burden of co-morbidities associated with CKD
• Women belonging to the lower income group

The two-year cumulative incidences of breast cancer screening were

• 61% among women without CKD,
• 54% for those with CKD stage 3,
• 37% for CKD stages 4 and 5,
• 26% for women with kidney failure who were on dialysis

Similar patterns were observed for the three-year cumulative incidences of cervical cancer screening.

Breast and Cervical Cancer Statistics

In the United States, breast cancer is the most common type of cancer that affects women after skin cancer. According to the American Cancer Society, breast cancer estimates for 2016 are

• Around 246, 660 new cases of invasive breast cancer
• Around 61,000 new cases of non-invasive breast cancer
• Around 40,450 women are expected to die due to breast cancer

In India, according to the Indian Council of Medical Research, there will be around 1.5 lakh new cases of breast cancer in 2016.

Cervical cancer is once one of the most common causes of cancer death for American women. According to the American Cancer Society, the estimates for cervical cancer in the United States for 2016 are

• About 12,990 new cases of invasive cervical cancer will be diagnosed.
• About 4,120 women will die from cervical cancer.

Most cases of cervical cancer occur in women younger than 50 years. It rarely develops in women younger than 20 years. About 20% of cervical cancers are found in women older than 65 years.

Increased used of Pap test has reduced the incidence of cervical cancer by 50% in the last 40 years. Pap test can detect early cancerous changes in the cervix and identify the disease when it is most curable.

Conclusion

The research team concluded that the main cause of lower screening rates among older women with advanced chronic kidney disease on dialysis may be because they may be lacking in capacity to deal with the complexity of dialysis management. This may have prompted them to potentially neglect less imminent issues such as preventive health care and early cancer detection.

"Given that cancer screening has the potential to improve cancer outcomes, targeted strategies to inform shared decision making in screening is critical." said Dr. Wong

In an accompanying editorial, Deidra Crews, MD, ScM and Waseem Khaliq, MBBS, MPH, (Johns Hopkins University School of Medicine) noted that "enhanced coordination of care between nephrologists, general practitioners and women's health care providers may serve to promote cancer screening among women with CKD. Ultimately, however, 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."

The findings appear in the Clinical Journal of the American Society of Nephrology (CJASN).

References:

1. Germaine Wong, et al. Patterns and Predictors of Screening for Breast and Cervical Cancer in Women with CKD. Clinical Journal of the American Society of Nephrology; (2016) doi:10.2215/CJN.05990616
2. About Chronic Kidney Disease - (https:www.kidney.org/kidneydisease/aboutckd)
3. Chronic kidney disease and cancer: a troubling connection - (https:www.ncbi.nlm.nih.gov/pmc/articles/PMC4823382/)
4. Inhibiting the GRP78 Protein in Estrogen Receptor-Positive Breast Cancer Reduces Resistance to Treatment - (https:www.medindia.net/news/healthinfocus/inhibiting-the-grp78-protein-in-estrogen-receptor-positive-breast-cancerreduces-resistance-to-treatment-163980-1.htm)
5. What are the key statistics about cervical cancer? - (http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-key-statistics)

Source: Medindia

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