This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Keating, N. L. Articles by Ayanian, J. Z. Search for Related Content PubMed PubMed Citation Articles by Keating, N. L. Articles by Ayanian, J. Z. Social Bookmarking                            What's this?

Factors Related to Underuse of Surveillance Mammography Among Breast Cancer Survivors

From the Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital; Department of Health Care Policy, Harvard Medical School; and Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA

Address reprint requests to Nancy L. Keating, MD, MPH, Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115; e-mail: keating{at}hcp.med.harvard.edu

PURPOSE: Many older breast cancer survivors do not undergo annual mammography despite guideline recommendations. We identified factors associated with underuse of surveillance mammography and examined whether variation was explained by differences in follow-up care.

PATIENTS AND METHODS: We used Surveillance, Epidemiology, and End Results-Medicare data to identify a population-based sample of 44,511 women fee-for-service Medicare enrollees aged 65 years who were diagnosed with stage I or II breast cancer in 1992 to 1999 who underwent primary surgical therapy. We assessed factors associated with mammography during months 7 to 18, 19 to 30, and 31 to 42 after breast cancer diagnosis using repeated-measures logistic regression; and we examined whether follow-up care with providers of various specialties explained variation in mammography use.

RESULTS: Only three quarters of women (77.6%) underwent mammography during months 7 to 18 after diagnosis, and only 56.7% had mammography yearly over 3 years. In multivariable analyses, women who were older, black, unmarried, and living in certain regions were less likely than other women to undergo surveillance mammography (all P < .05). Patients with more visits and patients who continued to see a medical oncologist, radiation oncologist, or surgeon were most likely to have mammograms (P < .001); however, adjusting for visits with providers did not explain the lower mammography rates based on age, race, marital status, and geographic region.

CONCLUSION: Many elderly breast cancer survivors do not undergo annual surveillance mammography, particularly women who are older, black, and unmarried, and this underuse was not explained by access to follow-up care. New strategies are needed to increase use of surveillance mammography and decrease variations based on nonclinical factors that are likely unrelated to appropriateness of medical care.

Supported by a Clinical Scientist Development Award from the Doris Duke Charitable Foundation (N.L.K.).

This study used the linked Surveillance, Epidemiology, and End Results-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				L. Nekhlyudov, L. A. Habel, N. S. Achacoso, I. Jung, R. Haque, L. C. Collins, S. J. Schnitt, C. P. Quesenberry Jr, and S. W. Fletcher Adherence to Long-Term Surveillance Mammography Among Women With Ductal Carcinoma In Situ Treated With Breast-Conserving Surgery J. Clin. Oncol., July 1, 2009; 27(19): 3211 - 3216. [Abstract] [Full Text] [PDF]

				L. Nekhlyudov "Doc, Should I See You or My Oncologist?" A Primary Care Perspective on Opportunities and Challenges in Providing Comprehensive Care for Cancer Survivors J. Clin. Oncol., May 20, 2009; 27(15): 2424 - 2426. [Full Text] [PDF]

				N. A. Bickell, K. Shastri, K. Fei, S. Oluwole, H. Godfrey, K. Hiotis, A. Srinivasan, and A. A. Guth A Tracking and Feedback Registry to Reduce Racial Disparities in Breast Cancer Care J Natl Cancer Inst, December 3, 2008; 100(23): 1717 - 1723. [Abstract] [Full Text] [PDF]

				P Donnelly, L Hiller, S Bathers, S Bowden, and R Coleman Questioning specialists' attitudes to breast cancer follow-up in primary care Ann. Onc., September 1, 2007; 18(9): 1467 - 1476. [Abstract] [Full Text] [PDF]

				N. L. Keating, M. B. Landrum, E. Guadagnoli, E. P. Winer, and J. Z. Ayanian Surveillance Testing Among Survivors of Early-Stage Breast Cancer J. Clin. Oncol., March 20, 2007; 25(9): 1074 - 1081. [Abstract] [Full Text] [PDF]

				J. Z. Ayanian and P. B. Jacobsen Enhancing Research on Cancer Survivors J. Clin. Oncol., November 10, 2006; 24(32): 5149 - 5153. [Abstract] [Full Text] [PDF]

				B. D. Smith, B. G. Haffty, A. Hurria, D. H. Galusha, and C. P. Gross Postmastectomy Radiation and Survival in Older Women With Breast Cancer J. Clin. Oncol., October 20, 2006; 24(30): 4901 - 4907. [Abstract] [Full Text] [PDF]