Diabetes-related barriers to cancer screening in women with type 2 diabetes: A qualitative interview study.

OBJECTIVES

People with type 2 diabetes (T2DM) are more likely to develop breast and bowel cancers. Despite this, cancer screening participation is lower among women with diabetes than among women without diabetes, indicating diabetes-related barriers to screening, but little research has examined this. This study aimed to identify and understand diabetes-related barriers to cancer screening, and potential ways to address these, among women with T2DM.

DESIGN

In-depth qualitative interviews.

METHODS

Semi-structured interviews with 25 women with T2DM, aged 50 to 74 years, living in England. Participants were recruited via diabetic eye screening clinics and community advertisement. Data were analysed to develop themes, using the framework method.

RESULTS

Women with T2DM were often living with an accumulated high burden of illness and its treatment, due to diabetes and comorbidities, which reduced their capacity to participate in cancer screening (e.g. physical and psychological capacities; practical resources). Having diabetes could complicate taking part in screening tests for some people (e.g. physical difficulties during screening related to diabetes, its treatment, complications or comorbidities; having to consider glycaemic control during appointments). There appeared to be underappreciation of the T2DM-increased risk of cancer, and limited cancer screening promotion within diabetes care.

CONCLUSIONS

Despite self-reported cancer screening uptake being high among study participants, having diabetes appeared to heighten common barriers to cancer screening (e.g. travel-related, logistical and scheduling barriers), whilst also posing additional unique barriers (e.g. diabetes-related stigma and embarrassment). Several potential strategies are suggested to improve cancer screening informed decision-making and participation among people with T2DM.