Breast Cancer Screening in Patients With Newly Diagnosed Lung and Colorectal Cancer: A Population-Based Study of Utilization.
OBJECTIVE
To assess breast cancer screening utilization in Medicare beneficiaries with colorectal and lung cancer versus cancer-free controls.


METHODS
Female fee-for-service Medicare beneficiaries who were ≥67 years old and diagnosed with lung or colorectal cancer between 2000 and 2011 and who reported to a Surveillance, Epidemiology, and End Results (SEER) registry (case group) were followed for 2 years after their diagnoses, unless death, a diagnosis of breast cancer, or the end of 2013 came first. A similar number of cancer-free controls were individually matched to cases by age, race, registry region, and follow-up time. Screening utilization was defined as the percentage of women with ≥1 screening mammogram during follow-up.


RESULTS
Overall, 104,164 cases (48% colorectal, 52% lung; 30% advanced cancer) and 104,164 controls were included. Among women with lung or colorectal cancer, 22% underwent ≥1 screening mammogram versus 26% of controls (odds ratio [OR] 0.80; 95% confidence interval [CI] 0.78-0.82). Stratified by cancer type, 28% of colorectal cancer cases versus 29% of controls (OR 0.98; 95% CI 0.95-1.01) and 17% of lung cancer cases versus 23% of controls (OR 0.63; 95% CI 0.60-0.65) received ≥1 mammogram. When stratified by stage, 8% with advanced cancer versus 18% of controls (OR 0.33; 95% CI 0.31-0.35) and 30% with early-stage cancer versus 30% of controls (OR 1; 95% CI 0.97-1.02) underwent ≥1 mammogram.


CONCLUSIONS
Screening mammography utilization rates are similar between Medicare beneficiaries with early-stage cancer versus controls. Although the majority of patients with advanced-stage cancer appropriately do not pursue screening mammography, a small number (8%) continue with screening.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia. Electronic address: gsadigh@emory.edu.
Gelareh
G
Sadigh
Department of Radiology, University of Michigan, Ann Arbor, Michigan.
Ruth C
RC
Carlos
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.
Kevin C
KC
Ward
Department of Biostatics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia.
Jeffrey M
JM
Switchenko
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia.
Renjian
R
Jiang
Department of Radiology, University of Kentucky, Lexington, Kentucky.
Kimberly E
KE
Applegate
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
Richard
R
Duszak
D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology*; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening; D006278:Medicare / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
Screening mammography; cancer survivorship period; population-based; utilization