title: Surveillance mammography among female Department of Defense beneficiaries: a study by race and ethnicity.
abstract: BACKGROUND
  Annual surveillance mammography is recommended after a diagnosis of breast cancer. Previous studies have suggested that surveillance mammography varies by demographics and initial tumor characteristics, which are related to an individual's access to health care. The Military Health System of the Department of Defense provides beneficiaries with equal access health care and thus offers an excellent opportunity to assess whether racial differences in surveillance mammography persist when access to care is equal.
  
  
  METHODS
  Among female beneficiaries with a history of breast cancer, logistic regression was used to assess racial/ethnic variations in the use of surveillance mammography during 3 periods of 12 months each, beginning 1 year after diagnosis adjusting for demographic, tumor, and health characteristics.
  
  
  RESULTS
  The rate of overall surveillance mammography decreased from 70% during the first year to 59% during the third year (P < .01). Although there was an overall tendency for surveillance mammography to be higher among minority women compared with non-Hispanic white women, after adjusting for covariates, the difference was found to be significant only during the first year among black women (odds ratio [OR], 1.46; 95% confidence interval [95% CI], 1.10-1.95) and the second year among Asian/Pacific Islander (OR, 2.29; 95%CI, 1.52-3.44) and Hispanic (OR, 1.92; 95%CI, 1.17-3.18) women. When stratified by age at diagnosis and type of breast cancer surgery performed, significant racial differences tended to be observed among younger women (aged < 50 years) and only among women who had undergone mastectomies.
  
  
  CONCLUSIONS
  Minority women were equally or more likely than non-Hispanic white women to receive surveillance mammography within the Military Health System. The racial disparities in surveillance mammography reported in other studies were not observed in a system with equal access to health care.
authors.affiliation: Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Rockville, Maryland; National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Enewold
authors.forename: Katherine A
authors.initials: KA
authors.lastname: McGlynn
authors.forename: Shelia H
authors.initials: SH
authors.lastname: Zahm
authors.forename: Ismail
authors.initials: I
authors.lastname: Jatoi
authors.forename: William F
authors.initials: WF
authors.lastname: Anderson
authors.forename: Abegail A
authors.initials: AA
authors.lastname: Gill
authors.forename: Craig D
authors.initials: CD
authors.lastname: Shriver
authors.forename: Kangmin
authors.initials: K
authors.lastname: Zhu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology* / Q000473:pathology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007342:Insurance Benefits / Q000706:statistics & numerical data*; D016015:Logistic Models; D008327:Mammography / Q000379:methods / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D014481:United States; D059030:United States Department of Defense / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American
keywords: breast cancer; epidemiology; health care access; mammography; surveillance; survivor
references.citation: Psychooncology. 2006 Jul;15(7):623-34
references.pmid: 16304623
references.citation: Eur J Cancer. 2011 Nov;47(17):2537-45
references.pmid: 21741825
references.citation: Br J Cancer. 2010 Jan 5;102(1):213-9
references.pmid: 19920826
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: Ann Surg Oncol. 2011 Apr;18(4):903-6
references.pmid: 21267787
references.citation: Med Care. 2010 Dec;48(12):1088-96
references.pmid: 20966779
references.citation: Cancer. 2006 Jun 1;106(11):2482-8
references.pmid: 16634097
references.citation: Natl Cancer Inst Monogr. 1985 Dec;68:99-112
references.pmid: 4088315
references.citation: J Gen Intern Med. 2008 Feb;23(2):158-63
references.pmid: 18060463
references.citation: Cancer. 2010 May 1;116(9):2090-8
references.pmid: 20198707
references.citation: Med Care. 2012 Mar;50(3):270-6
references.pmid: 22193416
references.citation: J Womens Health (Larchmt). 2008 Nov;17(9):1477-98
references.pmid: 18954237
references.citation: J Clin Oncol. 2006 Nov 1;24(31):5091-7
references.pmid: 17033037
references.citation: J Clin Oncol. 2006 Jan 1;24(1):77-84
references.pmid: 16382116
references.citation: J Clin Oncol. 1995 Jul;13(7):1578-83
references.pmid: 7602346
references.citation: Am J Epidemiol. 1992 Oct 15;136(8):925-36
references.pmid: 1456269
references.citation: J Cancer Surviv. 2010 Mar;4(1):59-66
references.pmid: 20091247
references.citation: Breast Cancer Res Treat. 2003 Sep;81(2):107-15
references.pmid: 14572153
references.citation: J Clin Oncol. 2006 Jan 1;24(1):85-94
references.pmid: 16382117
references.citation: Prev Chronic Dis. 2011 May;8(3):A59
references.pmid: 21477499
references.citation: Cancer Epidemiol Biomarkers Prev. 2008 Apr;17(4):748-57
references.pmid: 18381468
references.citation: Eur J Cancer. 2005 Oct;41(15):2331-7
references.pmid: 16140007