Breast cancer surveillance in women with intellectual disabilities

Breast cancer is the most frequent malignant neoplasm observed among women. For the subgroup of women with learning/intellectual disability, it is unclear whether their risk for breast cancer is as high as it is for the general population. Objective: Evaluation of breast cancer frequency and breast cancer screening in women with learning disability, focusing on Down syndrome. Method: Review of the literature.Results: The rather scant literature on the topic suggests women with learning disability may have the same or lower risk of breast cancer. The subgroup of women with Down syndrome has a lower risk of breast cancer. The absence of adequate, good-quality epidemiological data on this topic makes it difficult to evaluate any trend of increasing or decreasing risk for these women. However, given that medical achievements have seen significant gains in life expectancy for this group, it is likely that the number of women presenting with symptomatic breast cancer is increasing, even if the rate is unchanged. Evaluation of the literature on the use of mammography screening services suggests that women with learning disability may be either deliberately or passively excluded from screening programs. Uptake among those who are invited for mammography appears to be poor, and alternatives, such as clinical breast examination, appear to be underutilised. Conclusion: We suggest that women with learning disability should not be excluded from breast cancer screening services. Increased awareness of the risks of breast cancer among general practitioners and other health personnel is needed, as is the evaluation and development of appropriate screening methods for this special-needs population