Title

Under utilization of surveillance mammography among older breast cancer survivors.

UMMS Affiliation

Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine

Date

2-1-2008

Document Type

Article

Medical Subject Headings

Aged; Aged, 80 and over; Breast Neoplasms; Female; Follow-Up Studies; Health Maintenance Organizations; Humans; Mammography; Mass Screening; Neoplasm Recurrence, Local; Patient Compliance; Sentinel Surveillance; Survivors

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND: Annual surveillance mammography is recommended for follow-up of women with a history of breast cancer. We examined surveillance mammography among breast cancer survivors who were enrolled in integrated healthcare systems.

METHODS: Women in this study were 65 or older when diagnosed with early stage invasive breast cancer (N = 1,762). We assessed mammography use during 4 years of follow-up, using generalized estimating equations to account for repeated measurements.

RESULTS: Eighty-two percent had mammograms during the first year after treatment; the percentage declined to 68.5% in the fourth year of follow-up. Controlling for age and comorbidity, women who were at higher risk of recurrence by being diagnosed at stage II or receiving breast-conserving surgery (BCS) without radiation therapy were less likely to have yearly mammograms (compared to stage I, odds ratio [OR] for stage IIA 0.72, confidence interval [CI] 0.59, 0.87, OR for stage IIB 0.75, CI 0.57, 1.0; compared to BCS with radiation, OR 0.58, CI 0.43, 0.77). Women with visits to a breast cancer surgeon or oncologist were more likely to receive mammograms (OR for breast cancer surgeon 6.0, CI 4.9, 7.4, OR for oncologist 7.4, CI 6.1, 9.0).

CONCLUSIONS: Breast cancer survivors who are at greater risk of recurrence are less likely to receive surveillance mammograms. Women without a visit to an oncologist or breast cancer surgeon during a year have particularly low rates of mammography. Improvements to surveillance care for breast cancer survivors may require active participation by primary care physicians and improvements in cancer survivorship programs by healthcare systems.

Rights and Permissions

Citation: J Gen Intern Med. 2008 Feb;23(2):158-63. Epub 2007 Dec 1. Link to article on publisher's website

Related Resources

Link to article in PubMed

PubMed ID

18060463