Donald F Austin, MD, MPH, Dept of Public Health and Preventive Medicine, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Mailcode CB669, Portland, OR 97201-3098 and Gloria L. Krahn, PhD, MPH, Oregon Health & Science University, PO Box 574, Portland, OR 97201-0574, (503) 494-8364, krahng@ohsu.edu.

We examined the relationship between certain disabilities and the risk of being diagnosed with preventable cancer, and the risk of being diagnosed at a late stage. The research questions were: Do Medicaid enrollees with mental and physical disabilities have the same risk of smoking-related cancers as those with no disabilities? Are Medicaid enrollees with disabilities diagnosed with “screenable” cancers later than those without disabilities? If Medicaid enrollees with disabilities are at higher risk for preventable cancers or late diagnosis of screenable cancers, is this disparity due to differences in care?

Cancer incidence rates for smoking-related cancers for disabled and non-disabled Medicaid population categories were compared using rate ratio and 95% confidence limits. We used similar methodology to investigate stage of diagnosis for breast, cervix and/or colorectum cancer.

People with certain disabilities were at higher risk for smoking-related cancers and at higher risk for late diagnoses. We audited a randomly selected sample of 150 women age 50-74 from each of four groups (mobility, cognitive, both and no disability) who were enrolled at least 95% of the time (1996-98). Of these, 16% had no primary care provider (PCP) and nearly 10% had no medical visits in 3 years. Among those with a PCP, we obtained charts for half and found little difference in levels of screening existed for the four groups. Difference in screening was insufficient to account for the disparity in late stage diagnosis. We conclude that the disparity in stage at diagnosis between those with a disability (primarily cognitive) was not due to screening differences but was likely due to differences in symptom awareness.

Learning Objectives:

• Participants will have an increased awareness of the impact of inadequate cancer screening services for people with disabilities.
• Participants will be able to discuss the implications of the relationships between certain disabilities and the risk of preventable cancer and late diagnosis.
• Participants will recognize that extant administrative data can provide disability categorization adequate for research.

Keywords: Cancer Screening, Disability

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.