Providing care to disabled women. (Mammogram Adequacy an Issue).

Women with physical disabilities face two major obstacles in breast cancer screening: getting to the mammography clinic and, especially for women in wheelchairs or with spasticity, obtaining an adequate mammogram.

"Even patients who do go get mammograms often get suboptimal mammograms," said Dr. Debra Shabas, chief of the new Women's Center at Premier HealthCare in New York.

For example, the mammogram report for one patient who uses a wheelchair merely described the radiologist's "impression" of normal breast tissue because the report stated that very little of the breast could be visualized, said Dr. Shabas, a neurologist who spoke at the American Academy of Dermatology's Academy 2002 meeting in New York.

Her center provides multidisciplinary medical care and health promotion activities such as accessible exercise programs for women with diverse disabilities. The center was developed as part of a push in the past decade to increase access to health screenings for patients with disabilities.

Some of the barriers these women face are architectural: For example, some mammography centers are not wheelchair accessible. Other barriers are attitudinal. Too often clinicians fail to offer reproductive care or gynecologic exams to women with disabilities because they don't see them as sexual beings, said Florita Maiki, who manages the Breast Health Access for Women with Disabilities (BHAWD) program at Alta Bates Summit Medical Center, Berkeley, Calif.

A national survey of 11,389 women showed that among those aged 40 and older, 78% of those with no disabilities, 74% of those with one or two Functional limitations, and 71% of those with at least three functional limitations had ever had a mammogram (MMWR 47[40]:853-56, 1998).

Other studies, such as one by the Center for Research on Women With Disabilities, Baylor College of Medicine, Houston, and another by investigators at the University of Oregon, Portland, have found that women with disabilities are at least as likely as nondisabled women to get mammograms. The studies do not indicate, however, whether the mammograms were of adequate quality.