Vision Impairment Tied to Less Use of Cancer Screenings by Older Adults

By Lisa Rapaport

November 03, 2020

(Reuters Health) - Older adults with vision impairment are less likely to receive recommended breast and colon cancer screenings than peers without vision problems, a U.S. study suggests.

Researchers examined data from the 2015 and 2018 National Health Interview Survey (NHIS) as well as the 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) to assess the connection between vision impairment and the odds of recommended, age-appropriate screening for breast and colon cancer as well as the odds of recommended, age-appropriate pneumococcal and influenza vaccinations among adults 50 years and older.

Among participants in the NHIS, older adults with vision impairment were less likely to get breast cancer screenings (odds ratio 0.82) and colon cancer screenings (OR 0.89), the study found. But NHIS participants with vision impairment were not less likely to get pneumococcal vaccinations (OR 1.03) or influenza vaccinations (1.06).

In the BRFSS cohort, older adults with vision impairment were less likely to get breast cancer (OR 0.67) and colon cancer screenings (OR 0.70). Participants with vision impairment were also less likely to get pneumococcal vaccinations (OR 0.89) but not influenza vaccinations (OR 0.95).

"While the data used for our study does not include information on the reasons for not using preventive services, the healthcare system has many barriers for people with vision loss which may be magnified for cancer screening services," said senior study author Bonnielin Swenor, an associate professor at the Johns Hopkins Wilmer Eye Institute and director of the Johns Hopkins Disability Health Research Center in Baltimore.

"This type of care often requires transportation to new or specific testing sites which is difficult for people who do not drive as a result of vision loss, and can require following specific instructions, such as colonoscopy preparation, which may not be provided in accessible formats - including formats that are screen reader compatible, use alternative text to describe figures, or facilitate text magnification - for people with vision impairments," Swenor said by email.

The study assessed self-reported breast cancer screening for women aged 50 to 74 years, colon cancer screening for men and women aged 50 to 74 years, influenza vaccination for all participants, and pneumococcal vaccination for men and women aged 65 years and older. Researchers looked at vision impairment prevalence in both the NHIS and BRFSS survey populations for each of the four subgroups of screening and vaccination subpopulations.

Vision impairment prevalence ranged from 14.3% to 16.3% across each of the four subgroups (n = 12,120 to 29,654) of NHIS participants, and from 5.9% to 6.8% across each of the four BRFSS subgroups (n = 228,649 to 530,027).

Overall, 72.3% of women got recommended breast cancer screenings and 55.4% of women and men got recommended colon cancer screenings in the NHIS subgroups. In the BRFSS surveys, trends were similar, with somewhat lower proportions getting breast cancer and colon cancer screening, the study team notes in JAMA Ophthalmology.

One limitation of the study is that participation in the screenings and vaccinations was self-reported. Researchers also lacked data to determine whether physicians recommended screenings or vaccinations, and if so, whether patients followed through.

Even so, clinicians should consider the potential for vision loss to impact uptake of recommended screenings and vaccinations, to help prevent vision impairment from leading to excess morbidity and mortality, said Alan Morse, a researcher at the Harkness Eye Institute at Columbia University in New York City who wasn't involved in the study.

"Because vision loss is not always obvious nor are its implications for keeping appointments, taking medications, and other health behaviors, all patients should be asked if they are able to follow their physician's advice for their care and for follow-up and in obtaining recommended screenings such as colonoscopies and mammograms," Morse said by email.

"Eye care professionals can help their patients by educating their healthcare colleagues who may not understand fully the implications of vision loss," Morse added.

SOURCE: JAMA Ophthalmology, online October 29, 2020.