title: The effects of primary care on breast cancer mortality and incidence among Medicare beneficiaries.
abstract: BACKGROUND
  Primary care physician (PCP) services may have an impact on breast cancer mortality and incidence, possibly through greater use of screening mammography.
  
  
  METHODS
  The authors conducted a retrospective, 1:1 matching case-control study using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database to examine use of PCP services and their association with breast cancer mortality and incidence. SEER cases representing the 3 outcomes of interest (breast cancer mortality, all-cause mortality among women diagnosed with breast cancer, and breast cancer incidence) were matched to unaffected controls from the 5% Medicare random sample. Conditional logistic regression was used to examine associations between physician visits and breast cancer outcomes while controlling for other covariates.
  
  
  RESULTS
  Women who had 2 or more PCP visits during the 24-month assessment interval had lower odds of breast cancer mortality, all-cause mortality, and late-stage breast cancer diagnosis compared with women who had no PCP visits or 1 PCP visit while adjusting for other covariates, including mammography and non-PCP visits. Women who had 5 to 10 PCP visits had 0.69 times the odds of breast cancer mortality (95% confidence interval, 0.63-0.75), 0.83 times the odds of death from any cause having been diagnosed with breast cancer (95% confidence interval, 0.79-0.87), and 0.67 times the odds of a late-stage breast cancer diagnosis (95% confidence interval, 0.61-0.73) compared with those who had no PCP visits or 1 PCP visit.
  
  
  CONCLUSIONS
  The current findings suggest that PCPs play an important role in reducing breast cancer mortality among the Medicare population. Further research is needed to better understand the impact of primary care on breast cancer and other cancers that are amendable to prevention or early detection.
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
authors.forename: Kate J
authors.initials: KJ
authors.lastname: Fisher
authors.forename: Ji-Hyun
authors.initials: JH
authors.lastname: Lee
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Ferrante
authors.forename: Ellen P
authors.initials: EP
authors.lastname: McCarthy
authors.forename: Eduardo C
authors.initials: EC
authors.lastname: Gonzalez
authors.forename: Ren
authors.initials: R
authors.lastname: Chen
authors.forename: Kymia
authors.initials: K
authors.lastname: Love-Jackson
authors.forename: Richard G
authors.initials: RG
authors.lastname: Roetzheim
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000401:mortality; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D006278:Medicare / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States / Q000453:epidemiology
keywords: Medicare; SEER; breast neoplasms; mammography; primary health care