title: Health insurance and other factors associated with mammography surveillance among breast cancer survivors: results from a national survey.
abstract: BACKGROUND
  Whether disparities in mammography surveillance among breast cancer survivors exist by health insurance type is unclear.
  
  
  OBJECTIVE
  To determine the association of surveillance mammography with insurance and other factors among breast cancer survivors. DESIGN/PARTICIPANTS/MEASURES: We examined mammography within the prior year among 1511 breast cancer survivors aged 30 or older and ≥1 year after diagnosis from the 2000, 2003, 2005, and 2008 National Health Interview Surveys. Insurance included private (health maintenance organization/independent practice association, other, unspecified), Medicare+private, public only (Medicare+Medicaid, other Medicare, other public), and uninsured. Multivariable logistic regression was used to determine factors associated with mammography, including age, race/ethnicity, education, time since diagnosis, health status, insurance, income to poverty threshold ratios, having a usual provider, and survey year. Results are presented as predictive margins. For insurance, pairwise comparisons were used to compare Medicare+private versus other groups.
  
  
  RESULTS
  Overall 75% reported a mammogram. Mammography reporting was lower for uninsured survivors and those with only public insurance versus Medicare+private or private (50% and 68% vs. 76% and 80%, respectively; P=0.001). In each insurance group, 20% to 50% reported not receiving a mammogram. After adjustment, use remained lower for women with only public insurance versus Medicare+private (71% vs. 78%, P=0.029). Age of at least 75 years, greater time since diagnosis, and no usual provider were associated with not reporting a mammogram.
  
  
  CONCLUSIONS
  One in 4 breast cancer survivors did not report guideline-concordant mammography surveillance. Women with only public insurance were less likely than those with Medicare+private coverage to report a mammogram. Efforts to understand barriers and promote mammography among survivors are needed.
authors.affiliation: National Centers for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. SSabatino@cdc.gov
authors.forename: Susan A
authors.initials: SA
authors.lastname: Sabatino
authors.forename: Trevor D
authors.initials: TD
authors.lastname: Thompson
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Richardson
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Miller
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control*; D005260:Female; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008327:Mammography / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D012959:Socioeconomic Factors; D017741:Survivors / Q000706:statistics & numerical data; D014481:United States