Surveillance mammography for Medicaid/Medicare breast cancer patients.
BACKGROUND
Surveillance mammography for breast cancer survivors can detect recurrences early when treatment is most effective. We assessed the receipt of surveillance mammography for elderly breast cancer survivors considering their Medicaid and Medicare dual eligibility and minority status that may make them vulnerable to poor surveillance care.


METHODS
We analyzed Michigan Medicare and Medicaid data for patients, age 66 years or older, diagnosed with early stage breast cancer between 1997 and 2000. Using logistic regression and proportional hazards models, we identified individual and area level factors associated with patients' receipt and timeliness of surveillance mammography for up to 3 years post treatment.


RESULTS
In the first year post cancer treatment, patients who received breast conserving surgery (BCS) and radiation therapy were more likely to receive surveillance mammography than those treated with BCS alone (OR = 1.82; 95% CI = 1.48-2.24). Patients who received BCS and radiation treatment also had a greater probability of receiving surveillance mammography sooner than those treated with BCS alone (HR = 1.72; 95% CI = 1.56-1.89). Time from treatment to mammography was longer for older (80+ years) versus younger patients (HR = 0.55; 95% CI = 0.45-0.66) and for those with greater comorbidity burden (HR = 0.59; 95% CI = 0.43-0.81).


CONCLUSIONS
Regardless of race and dual eligibility, there is a greater likelihood for breast cancer patients who received BCS with radiation to receive surveillance mammography and to receive it sooner than for patients who were treated with BCS alone.


CONCLUSIONS
Dual eligible, black, and elderly patients are less likely to receive radiation following BCS, thus disparities across the treatment and surveillance continuum need to be further investigated.
Carcaise-Edinboro
Patricia
P
Department of Health Administration, Virginia Commonwealth University, 1008 E. Clay Street, Richmond, VA, 23298-0203, USA. pedinbor@vcu.edu
Bradley
Cathy J
CJ
Dahman
Bassam
B
D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D015412:Mastectomy, Segmental; D008484:Medicaid; D006278:Medicare; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D009367:Neoplasm Staging; D010349:Patient Compliance; D018426:SEER Program; D018571:Sentinel Surveillance; D017741:Survivors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology