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.