Under utilization of surveillance mammography among older breast cancer survivors.
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.
Field
Terry S
TS
Meyers Primary Care Institute, Worcester, MA 01605, USA. terry.field@umassmed.edu
Doubeni
Chyke
C
Fox
Matthew P
MP
Buist
Diana S M
DS
Wei
Feifei
F
Geiger
Ann M
AM
Quinn
Virginia P
VP
Lash
Timothy L
TL
Prout
Marianne N
MN
Yood
Marianne Ulcickas
MU
Frost
Floyd J
FJ
Silliman
Rebecca A
RA
D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D010349:Patient Compliance; D018571:Sentinel Surveillance; D017741:Survivors