Breast cancer appears to be the most common type of cancer in women and a leading cause of mortality worldwide. Disabled women are not an exception. The fact that cancer is more common in women over 50 and the fact that disabled women are living longer lives, accentuates the likelihood for them to develop this type of cancer. Because disabled women are reaching the age group where the risk of breast cancer rises with each decade of life, their rates of breast cancer are also deemed to increase.
Risk factors and breast cancer in women
Growing evidence suggests that disabled women are more likely to experience a greater number of risk factors related to breast cancer, thus placing them at an advanced threat of developing breast cancer compared with non-disabled women. These risk factors include leading a more sedentary lifestyle, low levels of exercise and consuming high-fat diets, all of which can contribute to obesity which is considered a significant risk factor. Furthermore, syndromes such as Down’s syndrome, Cowden syndrome, Fragile X, Pader-Willi and Angelman syndrome have been reported to augment the occurrence of breast cancer. In addition, there are risk factors common to all women, which disabled women also need to be aware of, such as not having given birth to children.
Breast cancerscreening
Breast cancer screening detects early cancers at a stage when treatment is likely to be effective. It is, therefore, essential that disabled women have access and follow the same screening principles and practices of the general population. However, concern has been expressed that disabled women are not taking up screening services in as large a proportion as non-disabled women.
It may also be the case that disabled women are dependent on their carers to identify relevant risk factors or signs and symptoms. These could potentially be wrongly attributed to the women’s primary disability, making disabled women more likely to be diagnosed at a more advanced stage of the disease due to delayed screening.
Women with physical and mobility impairments are reported to have significantly lower odds of receiving breast exams mammograms, representing an important shortfall in quality care. It is also a fact that screening premises are often inaccessible to these women.
Such circumstances hamper disabled women from early diagnosis of serious illnesses which would only be detected when it becomes visually evident, such as when a breast mass is formed.
Breast cancer accounts for around a third of all cancers in females
This is the case for women with cerebral palsy, where due to delayed diagnosis or treatment, mortality from breast carcinoma is known to be three times that of the general population.
Low literacy levels and poor communication skills are particularly known to inhibit breast screening awareness and regular attendance to screening of women with intellectual disabilities.
Mammography
Breast cancer is the most common cancer in Maltese women that accounts for around a third of all cancers in females. Currently in Malta, around 300 women are diagnosed with breast cancer each year.
Mammography has been introduced in many countries as part of breast screening programmes to reduce the mortality from breast cancer in women. Studies have shown that well-organised population-based mammography screening can substantially reduce deaths from breast cancer by as much as 30 per cent. In 2009, Eurostat had reported that among all other European Union countries, Malta had the highest rate of malignant breast cancer − 34.4 per 100,000 inhabitants in Malta, compared to 23.1 in other EU countries.
In 2009, Malta was among 19 member states that initiated the implementation of a breast-screening programme which invited Maltese and Gozitan women between the ages of 50 and 59 to free breast screenings over a three-year cycle.
This has now been extended to 69 years over a cycle of two-and-a-half years.
As a result, the screening programme has drastically reduced the number of fatalities due to early detection.
Women with both physical and intellectual impairments might face challenges to undergo the procedure, either because they are not easily accommodated by mammography scanners or because they might find it difficult to understand the procedure.
For women with physical impairment, the implications associated with mammography screening often render the process challenging. Implications involve not being able to stand up, stand still or stand straight enough for long enough. Other challenges include being a wheelchair user and being of short stature. Women with physical impairments, their families or service providers, might themselves believe they are physically unable to get into the required position to receive a mammogram or believe they are at a very low risk and opt out of screening.
The right to quality healthcare
Malta ratified the United Nations Convention on the Rights of Person with Disability in 2012, therefore, Malta is committed to the implementation of the articles of the convention. Article 25 of the convention requires signatory countries to: “Provide persons with disabilities with the same range, quality and standard of free or affordable healthcare and programmes as provided to other persons, including in the area of sexual and reproductive health and population-based public health programmes.” This is also reflected in Principle 6.4 of the National Disability Policy and the Principles of the National Disability Strategy.
Claire Azzopardi Lane is deputy dean of the Faculty of Social Wellbeing and heads the Department of Disability Studies at the University of Malta. Specialising in the field of disability and sexuality, Azzopardi Lane has worked in various sectors, including education and social care. Her doctoral research concerned elements of sexuality in people with intellectual disability in a Maltese context. Earlier this year, she was granted a Research Seed Fund by the University of Malta to embark on a project focusing on disabled women and access to breast cancer screening.