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Breast, cervical and colorectal cancer screening in adults with diabetes: a systematic review and meta-analysis

  • Dominika Bhatia
  • Iliana C. Lega
  • Wei Wu
  • Lorraine L. LipscombeEmail author



Individuals with diabetes are at increased risk of developing and dying from cancer. Evidence-based guidelines recommend universal screening for breast, cervical and colorectal cancer; however, evidence on the uptake of these tests in individuals with diabetes is mixed. We conducted a meta-analysis to quantify the association between diabetes and participation in breast, cervical and colorectal cancer screening.


MEDLINE, EMBASE and CINAHL were searched systematically for publications between 1 January 1997 and 18 July 2018. The search was supplemented by handsearching of reference lists of the included studies and known literature reviews. Abstracts and full texts were assessed in duplicate according to the following eligibility criteria: study conducted in the general population; diabetes included as a predictor vs a comparison group without diabetes; and breast (mammography), cervical (Papanicolaou smear) or colorectal (faecal and endoscopic tests) cancer screening uptake included as an outcome. Random-effects meta-analyses were performed using the most-adjusted estimates for each cancer site.


Thirty-seven studies (25 cross-sectional, 12 cohorts) were included, with 27 studies on breast, 19 on cervical and 18 on colorectal cancer screening. Having diabetes was associated with significantly lower likelihood of breast (adjusted OR 0.83 [95% CI 0.77, 0.90]) and cervical (OR 0.76 [95% CI 0.71, 0.81]) cancer screening, relative to not having diabetes. Colorectal cancer screening was comparable across groups with and without diabetes (OR 0.95 [95% CI 0.86, 1.06]); however, women with diabetes were less likely to receive a colorectal cancer screening test than women without diabetes (OR 0.86 [95% CI 0.77, 0.97]).


Our findings suggest that women with diabetes have suboptimal breast, cervical and colorectal cancer screening rates, compared with women without diabetes, although the absolute differences might be modest. Given the increased risk of cancer in this population, higher quality prospective evidence is necessary to evaluate the contribution of diabetes to cancer screening disparities in relation to other patient-, provider- and system-level factors.


PROSPERO registration ID CRD42017073107.


Breast cancer Cancer screening Cervical cancer Colorectal cancer Diabetes management Diabetes mellitus Healthcare barriers Healthcare disparities Meta-analysis Systematic review 



Faecal immunochemical test


Faecal occult blood test


Newcastle–Ottawa Scale




Prevalence ratio


Randomised controlled trial



We would like to thank V. Lui (Gerstein Science Information Centre, University of Toronto) for her guidance in the design of the electronic database search strategy. DB is supported by the Enid Walker Award in Women’s Health Research from Women’s College Hospital. LL is supported by the Diabetes Investigator Award from Diabetes Canada.

Contribution statement

DB, IL and LL conceived and designed the study. WW provided methodological and statistical advice. IL and LL provided clinical guidance in interpreting the results. DB, WW and IL assessed citations for eligibility and risk of bias. DB was involved in data abstraction, synthesis and drafting of the first version of the manuscript. All authors contributed critically to subsequent revisions and approved the final manuscript. All authors had full access to the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.


This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Supplementary material

125_2019_4995_MOESM1_ESM.pdf (515 kb)
ESM (PDF 515 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Dominika Bhatia
    • 1
  • Iliana C. Lega
    • 2
  • Wei Wu
    • 2
  • Lorraine L. Lipscombe
    • 1
    • 2
    Email author
  1. 1.Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  2. 2.Women’s College Research InstituteWomen’s College HospitalTorontoCanada

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