Adequacy of Cancer Screening in Adult Women with Congenital Heart Disease

Adults with congenital heart disease (ACHD) face noncardiac healthcare challenges as the population ages. We assessed whether women with ACHD have comparable cancer screening rates to non-ACHD women in a cardiac practice and to the general population. We performed a retrospective review of 175 adult women seen in a cardiac care center in 2009–2011. Data on Pap tests, mammography, and colonoscopies, were collected through electronic medical records and primary care provider records. Adequate documentation was available for 100 individuals with ACHD and 40 comparator cardiac patients. The adequacy of screening was determined using guidelines set forth by the American Cancer Society in 2010. Compared with the national average, ACHD patients had significantly lower rates of Pap tests (60% versus 83%, ) and mammography (48% versus 72%, ). Compared with non-ACHD women in the same practice, ACHD patients had consistently lower rates of mammography (48% versus 81%, ) and colonoscopies (54% versus 82%, ). As the population of ACHD individuals ages, attention to cancer screening becomes increasingly important but may be overlooked in this population. Primary care physicians and cardiologists should collaborate to ensure appropriate cancer screening for this growing population. 1. Background As a result of surgical advances as well as improvements in diagnosis and medical management, there may now be over 1 million adults with congenital heart disease in the United States, and this population is rapidly expanding [1]. As this population ages, the annual incidence of age-related malignancy rises, and caregivers must now ensure adequate and timely preventive cancer screening for the adult congenital heart disease (ACHD) patient. Primary care of the ACHD patient may be overshadowed by late cardiac complications including arrhythmia, valvular disease, and heart failure [2, 3]. The European Society of Cardiology and 2008 American College of Cardiology/American Heart Association guidelines have both called for increased access to primary care physicians and attention to health maintenance [4, 5]. To develop strategies to improve overall screening, it is essential to identify groups of individuals with inadequate screening rates and to assess potential barriers to preventive screening. Known risk factors for poor participation in preventive screening include low socioeconomic status, lower levels of education, immigrant status, lack of health insurance and importantly, lack of a primary care provider [6]. Individuals with chronic disease rely on subspecialists for their