Disparities in long-term breast cancer screening adherence among women with disabilities: a 10-year nationwide cohort study

Women with disabilities face substantial disparities in breast cancer screening, detection, and treatment, resulting in poorer outcomes. We investigated disparities in 10-year cumulative adherence to biennial breast cancer screening associated with disability status and disability characteristics, including type and severity. This retrospective cohort study used data from the Korean National Cancer Screening Program Data and Korea National Disability Registration System. The total cohort comprised 4,956,744 women who participated in screening from 2011 to 2012 and were followed for 10 years. We ascertained the presence, type, and severity of medically verified disabilities. The 15 officially defined disability types were grouped into six categories: physical, brain injury, communication, major internal organ, intellectual disability and autism, and mental disorder. The primary outcome was completion of all five recommended biennial screening cycles. Women with disabilities had lower odds of completing all five screenings compared to those without disabilities. A gradient pattern was observed by disability severity, with lower adherence among women with severe disabilities and slightly higher adherence among those with mild disabilities. Screening adherence also differed by disability type, with the lowest participation among women with intellectual disability and autism and the highest participation among those with physical disabilities. Even with reduced or eliminated financial barriers, significant disparities were found in breast cancer screening participation, especially in women with severe disabilities and intellectual disability and autism. Policy efforts, such as a disability-responsive design and routine equity monitoring should be made to decrease this disparity in organized screening programs.