3 questions to… Anne Penneau and Sylvain Pichetti following the publication of Issues in Health Economics n° 256, March 2021: "Women's Cancer Prevention and Disabilities: Do Institutions Provide Better Access?"
Both at home and in institutions, disabled women are identified in our study through the fact that they had reported difficulty in performing at least one personal activity of daily living (washing, dressing, personal hygiene, etc.) or at least one instrumental activity of daily living (shopping, cleaning, etc.). Among these women eligible for female cancer screening, aged between 25 and 75, those living in medical-social facilities [Non-medicalized residential facilities (foyers de vie and foyers d'hébergement), Specialised care homes (MAS, Maisons d'accueil spécialisées), Medical-Care homes (FAM, Foyers d'accueil médicalisé), Nursing homes for dependent elderly persons (EHPAD, Etablissements d'hébergement pour personnes âgées dépendantes), Long-term care facilities (USLD, Unités de soins de longue durée) have very different characteristics from those living at home. Thus, women living in institutions were more often dependent, had multiple disabilities and were also much less socially integrated. These differences in characteristics may explain differences in the use of female cancer screening between these two populations, which is why we control for these differences in order to compare the screening rates of women living in institutions with those of women living at home.
Around 44% of women residing in institutions reported that they had been screened for cervical cancer and 54% had been screened for breast cancer. After taking into account the differences in individual characteristics between disabled women living in institutions and at home, we determined that institutions facilitate access to preventive care. Hence, disabled women residing in institutions were significantly more likely (+15 points) to report that they had been screened for cervical cancer and more likely (+5 points) to report that they had been screened for breast cancer compared with disabled women residing at home.
These results seem to show overall positive effects of institutions on the use of female cancer prevention services. In non-medicalized and medicalized residential facilities, in which disabled women lived, the declared breast cancer screening rates were around 70%. Compared with disabled women with comparable characteristics living at home, these rates were 20 points (non-medicalized facilities) to 35 points (medicalized facilities) higher. However, for elderly women residing in nursing homes for dependent elderly persons, the declared breast cancer screening rate (less than 50%) was lower than in the institutions for disabled women. Furthermore, we did not identify a difference in the use of cancer screening services compared with comparable elderly women residing at home.
For cervical cancer screening, a significant difference was observed in the screening rates between medicalized residential facilities (26%) and non-medicalized residential facilities (61%). Although these rates were almost two times higher than those reported by comparable disabled women residing at home, the question of the benefits compared with the problems and mental disorders that could result from this type of invasive procedure amongst women in medicalized residential facilities remains to be investigated.