title: Bone Density Screening in Postmenopausal Women With Early-Stage Breast Cancer Treated With Aromatase Inhibitors.
abstract: In postmenopausal women with breast cancer treated with aromatase inhibitors (AIs), most expert panels advise baseline bone mineral density testing with a dual-energy x-ray absorptiometry (DXA) scan repeated every 1 to 2 years. How often this recommendation is followed is unclear.
  
  
  
  We performed a retrospective analysis of women with stage I to III breast cancer who started AI therapy from January 1, 2008, to December 31, 2010, with follow-up through December 31, 2012, by using the SEER-Medicare database. Selection criteria included AI use for ≥ 6 months and no recent osteoporosis diagnosis or bisphosphonate use. We used multivariable logistic regression to investigate associations between patient characteristics and receipt of a baseline DXA scan. In patients who continued AI treatment, we assessed rates of follow-up scans.
  
  
  
  In the sample of 2,409 patients (median age, 74 years), 51.0% received a baseline DXA scan. Demographic characteristics associated with the absence of a baseline DXA scan were older age (85 to 94 years v 67 to 69 years; odds ratio [OR], 0.62; 95% CI, 0.42 to 0.92) and black v white race (OR, 0.68; 95% CI, 0.47 to 0.97). Among patients who underwent a baseline DXA scan and continued AI for 3 years, 28.0% had a repeat DXA scan within 2 years and 65.9% within 3 years. In aggregate, of the 1,164 patients who continued with AI treatment for 3 years, only 34.5% had both a baseline and at least one DXA scan during the 3-year follow-up period.
  
  
  
  The majority of older Medicare beneficiaries with breast cancer treated with AIs do not undergo appropriate bone mineral density evaluation.
authors.affiliation: Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT.
authors.forename: Jamie
authors.initials: J
authors.lastname: Stratton
authors.affiliation: Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT.
authors.forename: Xin
authors.initials: X
authors.lastname: Hu
authors.affiliation: Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT.
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.affiliation: Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Davidoff
authors.affiliation: Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT.
authors.forename: Lajos
authors.initials: L
authors.lastname: Pusztai
authors.affiliation: Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT.
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
authors.affiliation: Yale University School of Medicine; and Yale Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, New Haven, CT.
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Mougalian
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D047072:Aromatase Inhibitors / Q000627:therapeutic use; D015519:Bone Density; D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016017:Odds Ratio; D010024:Osteoporosis / Q000175:diagnosis* / Q000209:etiology*; D017698:Postmenopause; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program
chemical_list: D047072:Aromatase Inhibitors