Presence of Multi-Morbidities and Colorectal Cancer Screening Utilization among Breast Cancer Survivors

SIMPLE SUMMARY: Breast cancer survivors have an increased risk of developing colorectal cancer (CRC) due to shared risk factors; thus, adherence to CRC screening recommendation should be prioritized for breast cancer survivors. Further, breast cancer survivors with multiple chronic diseases commonly experience poorer survival outcomes. These together highlight the need for evaluation and management of their chronic disease conditions. Understanding their chronic disease conditions may assist providers offering appropriate screening recommendations for CRC. Through our cross-sectional study, we sought to examine the association between the presence of multiple chronic disease conditions (e.g., diabetes and coronary heart disease) and guideline-concordant CRC screening utilization. Further, we determined the factors in sociodemographic characteristics, quality of life, and cancer-related factors associated with screening uptake among breast cancer survivors. Findings from this study suggest the importance of chronic disease management considering mental/physical health status and other factors (race/ethnicity or receipt of follow-up care plans) in cancer survivorship care. ABSTRACT: Purpose: Our study aimed to examine the association between the presence of chronic diseases with guideline-concordant colorectal cancer (CRC) screening utilization among breast cancer survivors. Methods: We analyzed data among women with a history of breast cancer from the 2016, 2018, and 2020 Behavioral Risk Factor Surveillance System. Receipt of guideline-concordant CRC screening was the outcome of interest. Diabetes, coronary heart disease/myocardial infarction, stroke, chronic obstructive pulmonary disease, emphysema/chronic bronchitis, arthritis, depressive disorder, or kidney diseases were included in chronic disease conditions. Results: Among 1324 survivors, those with multi-morbidities (3+ chronic diseases; 88.3%) had higher CRC screening use compared to those with one (84.4%) or two (85.4%) diseases (p-value < 0.05). In multivariable analysis, survivors with multi-morbidities were two times more likely to have CRC screening compared to those with only one disease (OR, 2.10; 95% CI, 1.11–3.98). Among survivors with multi-morbidities, Black women (OR, 14.07; 95% CI, 5.61–35.27), and those with frequent poor physical health (OR, 3.32; 95% CI, 1.57–7.00) were positively associated with CRC screening use. Conversely, survivors with frequent poor mental health were 67% less likely to receive CRC screening (OR, 0.33; 95% CI, 0.14–0.74). Conclusion: Among breast cancer survivors, multi-morbidities were positively associated with CRC screening.