AIMS/HYPOTHESIS Individuals with diabetes are at increased risk of developing and dying from cancer. Evidence-based guidelines recommend universal screening for breast, cervical and colorectal cancer; however, evidence on the uptake of these tests in individuals with diabetes is mixed. We conducted a meta-analysis to quantify the association between diabetes and participation in breast, cervical and colorectal cancer screening. METHODS MEDLINE, EMBASE and CINAHL were searched systematically for publications between 1 January 1997 and 18 July 2018. The search was supplemented by handsearching of reference lists of the included studies and known literature reviews. Abstracts and full texts were assessed in duplicate according to the following eligibility criteria: study conducted in the general population; diabetes included as a predictor vs a comparison group without diabetes; and breast (mammography), cervical (Papanicolaou smear) or colorectal (faecal and endoscopic tests) cancer screening uptake included as an outcome. Random-effects meta-analyses were performed using the most-adjusted estimates for each cancer site. RESULTS Thirty-seven studies (25 cross-sectional, 12 cohorts) were included, with 27 studies on breast, 19 on cervical and 18 on colorectal cancer screening. Having diabetes was associated with significantly lower likelihood of breast (adjusted OR 0.83 [95% CI 0.77, 0.90]) and cervical (OR 0.76 [95% CI 0.71, 0.81]) cancer screening, relative to not having diabetes. Colorectal cancer screening was comparable across groups with and without diabetes (OR 0.95 [95% CI 0.86, 1.06]); however, women with diabetes were less likely to receive a colorectal cancer screening test than women without diabetes (OR 0.86 [95% CI 0.77, 0.97]). CONCLUSIONS/INTERPRETATION Our findings suggest that women with diabetes have suboptimal breast, cervical and colorectal cancer screening rates, compared with women without diabetes, although the absolute differences might be modest. Given the increased risk of cancer in this population, higher quality prospective evidence is necessary to evaluate the contribution of diabetes to cancer screening disparities in relation to other patient-, provider- and system-level factors. REGISTRATION PROSPERO registration ID CRD42017073107.

中文翻译：

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成人糖尿病患者的乳腺癌、宫颈癌和结直肠癌筛查：系统评价和荟萃分析。

目的/假设 糖尿病患者患癌症和死于癌症的风险增加。循证指南建议对乳腺癌、宫颈癌和结直肠癌进行普遍筛查；然而，关于糖尿病患者接受这些测试的证据好坏参半。我们进行了一项荟萃分析，以量化糖尿病与参与乳腺癌、宫颈癌和结直肠癌筛查之间的关联。方法 系统检索了 1997 年 1 月 1 日至 2018 年 7 月 18 日期间的 MEDLINE、EMBASE 和 CINAHL 出版物。通过手动检索纳入研究的参考文献列表和已知文献综述​​来补充检索。根据以下资格标准对摘要和全文进行一式两份的评估：在一般人群中进行的研究；与没有糖尿病的对照组相比，将糖尿病作为预测因子；乳腺癌（乳房X光检查）、宫颈癌（巴氏涂片）或结直肠癌（粪便和内窥镜检查）筛查结果也包括在内。使用每个癌症部位的最调整估计值进行随机效应荟萃分析。结果 纳入 37 项研究（25 项横断面研究，12 个队列），其中 27 项研究涉及乳腺癌，19 项研究涉及宫颈癌，18 项研究涉及结直肠癌筛查。与未患糖尿病相比，患有糖尿病的乳腺癌（调整后 OR 0.83 [95% CI 0.77，0.90]）和宫颈癌（OR 0.76 [95% CI 0.71，0.81]）筛查的可能性显着降低。患有和不患有糖尿病的组之间结直肠癌筛查具有可比性（OR 0.95 [95% CI 0.86, 1.06]）；然而，与未患糖尿病的女性相比，患有糖尿病的女性接受结直肠癌筛查的可能性较低（OR 0.86 [95% CI 0.77, 0.97]）。结论/解释 我们的研究结果表明，与未患糖尿病的女性相比，患有糖尿病的女性的乳腺癌、宫颈癌和结直肠癌筛查率较差，尽管绝对差异可能不大。鉴于该人群患癌症的风险增加，需要更高质量的前瞻性证据来评估糖尿病与其他患者、提供者和系统层面因素相关的癌症筛查差异的影响。注册 PROSPERO 注册 ID CRD42017073107。