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In a well-conducted retrospective cohort study, Lipscombe and colleagues¹ found that women with diabetes had roughly two-thirds the odds of having a mammogram as women without diabetes. The investigators were able to adjust for women's age, region of residence, income, number of visits, specialty care, and the presence of unstable chronic disease; of note, this Canadian cohort was fully insured for mammography. They conclude that diabetes care may "compete" with cancer screening.

As the authors note in their discussion, an alternate explanation is that the factors that contribute to diabetes and diabetes care may also contribute to poorer cancer screening. We were able to examine this issue more closely in our study recently published in Diabetes Care.² Using data from a US prospective cohort study of diabetes care in managed care, we were able to examine the association between mammography and diabetes processes of care (measurement of hemoglobin A_1c. . . [Full Text of this Article]

AUTHOR INFORMATION
Catherine Kim, MD, MPH; Bahman P. Tabaei, MPH; William H. Herman, MD, MPH

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