title: Tumor marker usage and medical care costs among older early-stage breast cancer survivors.
abstract: OBJECTIVE
  Although American Society of Clinical Oncology guidelines discourage the use of tumor marker assessment for routine surveillance in nonmetastatic breast cancer, their use in practice is uncertain. Our objective was to determine use of tumor marker tests such as carcinoembryonic antigen and CA 15-3/CA 27.29 and associated Medicare costs in early-stage breast cancer survivors.
  
  
  METHODS
  By using Surveillance, Epidemiology, and End Results-Medicare records for patients diagnosed with early-stage breast cancer between 2001 and 2007, tumor marker usage within 2 years after diagnosis was identified by billing codes. Logistic regression models were used to identify clinical and demographic factors associated with use of tumor markers. To determine impact on costs of care, we used multivariable regression, controlling for other factors known to influence total medical costs.
  
  
  RESULTS
  We identified 39,650 eligible patients. Of these, 16,653 (42%) received at least one tumor marker assessment, averaging 5.7 tests over 2 years, with rates of use per person increasing over time. Factors significantly associated with use included age at diagnosis, diagnosis year, stage at diagnosis, race/ethnicity, geographic region, and urban/rural status. Rates of advanced imaging, but not biopsies, were significantly higher in the assessment group. Medical costs for patients who received at least one test were approximately 29% greater than costs for those who did not, adjusting for other factors.
  
  
  CONCLUSIONS
  Breast cancer tumor markers are frequently used among women with early-stage disease and are associated with an increase in both diagnostic procedures and total cost of care. A better understanding of factors driving the use of and the potential benefits and harms of surveillance-based tumor marker testing is needed.
authors.affiliation: Scott D. Ramsey, Julie R. Gralow, Dana K. Mirick, William Barlow, Ruth Etzioni, and David Mummy, Fred Hutchinson Cancer Research Center; Scott D. Ramsey, Julie R. Gralow, Rahber Thariani, and David L. Veenstra, University of Washington, Seattle, WA; and N. Lynn Henry, University of Michigan, Ann Arbor, MI. sramsey@fhcrc.org.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Ramsey
authors.affiliation: Scott D. Ramsey, Julie R. Gralow, Dana K. Mirick, William Barlow, Ruth Etzioni, and David Mummy, Fred Hutchinson Cancer Research Center; Scott D. Ramsey, Julie R. Gralow, Rahber Thariani, and David L. Veenstra, University of Washington, Seattle, WA; and N. Lynn Henry, University of Michigan, Ann Arbor, MI.
authors.forename: N Lynn
authors.initials: NL
authors.lastname: Henry
authors.affiliation: Scott D. Ramsey, Julie R. Gralow, Dana K. Mirick, William Barlow, Ruth Etzioni, and David Mummy, Fred Hutchinson Cancer Research Center; Scott D. Ramsey, Julie R. Gralow, Rahber Thariani, and David L. Veenstra, University of Washington, Seattle, WA; and N. Lynn Henry, University of Michigan, Ann Arbor, MI.
authors.forename: Julie R
authors.initials: JR
authors.lastname: Gralow
authors.affiliation: Scott D. Ramsey, Julie R. Gralow, Dana K. Mirick, William Barlow, Ruth Etzioni, and David Mummy, Fred Hutchinson Cancer Research Center; Scott D. Ramsey, Julie R. Gralow, Rahber Thariani, and David L. Veenstra, University of Washington, Seattle, WA; and N. Lynn Henry, University of Michigan, Ann Arbor, MI.
authors.forename: Dana K
authors.initials: DK
authors.lastname: Mirick
authors.affiliation: Scott D. Ramsey, Julie R. Gralow, Dana K. Mirick, William Barlow, Ruth Etzioni, and David Mummy, Fred Hutchinson Cancer Research Center; Scott D. Ramsey, Julie R. Gralow, Rahber Thariani, and David L. Veenstra, University of Washington, Seattle, WA; and N. Lynn Henry, University of Michigan, Ann Arbor, MI.
authors.forename: William
authors.initials: W
authors.lastname: Barlow
authors.affiliation: Scott D. Ramsey, Julie R. Gralow, Dana K. Mirick, William Barlow, Ruth Etzioni, and David Mummy, Fred Hutchinson Cancer Research Center; Scott D. Ramsey, Julie R. Gralow, Rahber Thariani, and David L. Veenstra, University of Washington, Seattle, WA; and N. Lynn Henry, University of Michigan, Ann Arbor, MI.
authors.forename: Ruth
authors.initials: R
authors.lastname: Etzioni
authors.affiliation: Scott D. Ramsey, Julie R. Gralow, Dana K. Mirick, William Barlow, Ruth Etzioni, and David Mummy, Fred Hutchinson Cancer Research Center; Scott D. Ramsey, Julie R. Gralow, Rahber Thariani, and David L. Veenstra, University of Washington, Seattle, WA; and N. Lynn Henry, University of Michigan, Ann Arbor, MI.
authors.forename: David
authors.initials: D
authors.lastname: Mummy
authors.affiliation: Scott D. Ramsey, Julie R. Gralow, Dana K. Mirick, William Barlow, Ruth Etzioni, and David Mummy, Fred Hutchinson Cancer Research Center; Scott D. Ramsey, Julie R. Gralow, Rahber Thariani, and David L. Veenstra, University of Washington, Seattle, WA; and N. Lynn Henry, University of Michigan, Ann Arbor, MI.
authors.forename: Rahber
authors.initials: R
authors.lastname: Thariani
authors.affiliation: Scott D. Ramsey, Julie R. Gralow, Dana K. Mirick, William Barlow, Ruth Etzioni, and David Mummy, Fred Hutchinson Cancer Research Center; Scott D. Ramsey, Julie R. Gralow, Rahber Thariani, and David L. Veenstra, University of Washington, Seattle, WA; and N. Lynn Henry, University of Michigan, Ann Arbor, MI.
authors.forename: David L
authors.initials: DL
authors.lastname: Veenstra
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D001943:Breast Neoplasms / Q000097:blood* / Q000191:economics* / Q000473:pathology; D015897:Comorbidity; D005163:Factor Analysis, Statistical; D005260:Female; D017048:Health Care Costs; D006801:Humans; D016015:Logistic Models; D006278:Medicare; D009367:Neoplasm Staging; D011159:Population Surveillance / Q000379:methods*; D012307:Risk Factors; D018426:SEER Program; D017741:Survivors / Q000706:statistics & numerical data; D014481:United States
chemical_list: D014408:Biomarkers, Tumor