title: Ethnic disparities in adherence to breast cancer survivorship surveillance care.
abstract: BACKGROUND
  Adherence to guidelines for surveillance mammography and clinic visits is an important component of breast cancer survivorship care. Identifying ethnic disparities in adherence may lead to improved care delivery and outcomes.
  
  
  METHODS
  Records were evaluated for 4535 patients who were treated for stage I, II, or III breast cancer at the University of Texas MD Anderson Cancer Center, Houston, Texas, cancer center between January 1997 and December 2006. Generalized estimating equations and Cox proportional hazards analyses were used to evaluate ethnic differences in missed mammograms and clinic visits up to 4 years of follow-up and the impact of those differences on overall survival.
  
  
  RESULTS
  Nonadherence to guidelines for mammography (P = .0002) and clinic visits (P < .0001) increased over time. Hispanic and black patients were more likely to be nonadherent to guidelines for mammography (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.10-1.65; OR = 1.36, 95% CI = 1.11-1.66, respectively) and clinic visits (OR = 1.62, 95% CI = 1.27-2.06; OR = 1.45, 95% CI = 1.13-1.86, respectively) than white patients. There was an interaction between Hispanic ethnicity and endocrine therapy on nonadherence to mammography guidelines (P = .001). Nonadherence to mammography and clinic visit guidelines was not associated with overall survival.
  
  
  CONCLUSIONS
  Withdrawal from breast cancer survivorship care increases over time, and black and Hispanic patients are more likely to be nonadherent. An understanding of the reasons for ethnic disparities in adherence to guidelines for mammography and clinic visits is needed to improve retention in survivorship care.
authors.affiliation: Department of Health Promotion and Behavioral Sciences, University of Texas (UT) School of Public Health, Houston, Texas.
authors.forename: Pragati S
authors.initials: PS
authors.lastname: Advani
authors.forename: Jun
authors.initials: J
authors.lastname: Ying
authors.forename: Richard
authors.initials: R
authors.lastname: Theriault
authors.forename: Amal
authors.initials: A
authors.lastname: Melhem-Bertrand
authors.forename: Stacy
authors.initials: S
authors.lastname: Moulder
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.forename: Welela
authors.initials: W
authors.lastname: Tereffe
authors.forename: Shon
authors.initials: S
authors.lastname: Black
authors.forename: Tunghi May
authors.initials: TM
authors.lastname: Pini
authors.forename: Abenaa M
authors.initials: AM
authors.lastname: Brewster
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*; D003695:Delivery of Health Care; D055088:Early Detection of Cancer; D005006:Ethnicity; D005260:Female; D019983:Guideline Adherence; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D010349:Patient Compliance; D012189:Retrospective Studies; D013534:Survival; D015996:Survival Rate; D013781:Texas; D016896:Treatment Outcome
keywords: breast cancer; ethnicity; health care disparities; patient adherence; surveillance; survivorship