The effect of comorbid illness on receipt of cancer screening by older people

Objectives: To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people. Design: Sixth annual follow-up of a community-based survey with 4,162 participants aged 65 and older at baseline in 1986. Setting: Piedmont area of North Carolina Participants: Two thousand two hundred twenty-five subjects with a mean age of 79 who responded in 1992. Measurements: Self-reported receipt of clinical breast examination, mammography, Papanicolaou (Pap) smear, and fecal occult blood testing (FOBT) within the 2 years before the survey. Results: Hip fracture was associated with lower rates of mammography (odds ratio (OR)=0.53, 95% confidence interval (CI)=0.32-0.87) and cognitive impairment with lower rates of FOBT (OR=0.71, 95% CI=0.54-0.94). Hypertension was associated with higher rates of breast examination (OR=1.56, 95% CI=1.18-2.07), Pap smear (OR=1.41, 95% CI=1.09-1.83), and FOBT (OR=1.37, 95% CI=1.12-1.66) and a trend toward increasing rates of mammography (OR=1.28, 95% CI=0.98-1.69). The presence of three or more comorbid conditions was associated with an increased rate of mammography (OR=1.35, 95% CI=1.06-1.71), breast examination (OR=1.46, 95% CI=1.12-1.89), and Pap smear (OR=1.31, 95% CI=1.04-1.65). Conclusions: With few exceptions, the presence of comorbid conditions is not associated with a decreased rate of receipt of screening. In fact, hypertension and the presence of a higher number of comorbid conditions are associated with a higher rate of receipt of cancer screening. This finding may be due to an increase in the frequency of office visits increasing the opportunity for cancer screening.