Breast and cervical cancer screening in females with spinal cord injury: A systematic review and meta-analysis

Breast and cervical cancer are among the most common types of cancer, with breast cancer being a leading cause of death in females. Participation in preventive cancer screening is thought to be lower for females with spinal cord injury (SCI) compared to the general population, which could lead to late diagnosis and increased mortality. To summarize evidence on the prevalence of breast and cervical cancer, adherence to cancer screening recommendations, and factors influencing participation in preventive programs among females with SCI. Systematic searches were conducted in PubMed, Embase, a guideline repository, and two SCI-specific websites for articles published between 1990 and 2023. The risk of bias was assessed using different critical appraisal tools. Fixed-effects meta-analysis estimated differences in adherence to mammography and Pap testing recommendations between females with and without SCI. Prospero registration: CRD42023481362. We identified 15 studies, mainly from high-income countries, with a cumulative study population of 9,565 people. No studies evaluated cervical or breast cancer prevalence in females with SCI. Meta-analysis found females with SCI had 1.4 times the odds of not having a recent mammogram and 1.8 times the odds of not having a recent pap test, compared to females without SCI. Barriers included environmental, attitudinal, financial, and informal factors. There is no information on the prevalence of cervical or breast cancer in females with SCI. Participation in breast and cervical cancer screening is lower among females with SCI. Physical inaccessibility of health care and lack of provider knowledge were the main barriers.