Depressive Symptom Burden as a Barrier to Screening for Breast and Cervical Cancers

Background: Depression has been associated with lower cancer screening rates in some studies. We examined whether a higher depressive symptom burden presented a barrier to subsequent mammography and Papanicolaou (Pap) smear testing.

Methods: Study of Women's Health Across the Nation (SWAN) is a cohort study of 3302 community-dwelling women. At baseline, participants were 42–52 years old, had no surgical removal of the uterus or both ovaries, no current use of hormones that affect the ovaries, and at least one menses in the previous 3 months. SWAN data spanned 4 years. Repeated measures logistic models determined odds of mammography and of Pap screening in the year following depressive symptom burden, as determined by Center for Epidemiological Studies Depression score (CES-D). The models controlled for age, race/ethnicity, health insurance, medical history and use, smoking, obesity, and socioeconomic status.

Results: At baseline, 75.6% (2493 of 3297) had a low depressive symptom burden (CES-D score <16, referent), 9.5% (312 of 3297) had a moderate burden (CES-D 16-20), and 14.9%(492/3297) had a high burden (CES-D ≥ 21). Women with a high depressive symptom burden had, in the subseqent year, significantly lower odds of mammography (OR 0.84, 95% CI 0.73- 0.97) but not Pap smear (OR 0.88, 95% CI 0.76-1.03). There was not a significant dose-response relationship between depressive symptom burden and screening.

Conclusions: The presence of a high depressive symptom burden is a modest independent risk factor for lack of subsequent mammography. Ensuring that depressed patients receive regular cancer screening services is important.