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Under Utilization of Surveillance Mammography among Older Breast Cancer Survivors

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Abstract

Background

Annual surveillance mammography is recommended for follow-up of women with a history of breast cancer. We examined surveillance mammography among breast cancer survivors who were enrolled in integrated healthcare systems.

Methods

Women in this study were 65 or older when diagnosed with early stage invasive breast cancer (N = 1,762). We assessed mammography use during 4 years of follow-up, using generalized estimating equations to account for repeated measurements.

Results

Eighty-two percent had mammograms during the first year after treatment; the percentage declined to 68.5% in the fourth year of follow-up. Controlling for age and comorbidity, women who were at higher risk of recurrence by being diagnosed at stage II or receiving breast-conserving surgery (BCS) without radiation therapy were less likely to have yearly mammograms (compared to stage I, odds ratio [OR] for stage IIA 0.72, confidence interval [CI] 0.59, 0.87, OR for stage IIB 0.75, CI 0.57, 1.0; compared to BCS with radiation, OR 0.58, CI 0.43, 0.77). Women with visits to a breast cancer surgeon or oncologist were more likely to receive mammograms (OR for breast cancer surgeon 6.0, CI 4.9, 7.4, OR for oncologist 7.4, CI 6.1, 9.0).

Conclusions

Breast cancer survivors who are at greater risk of recurrence are less likely to receive surveillance mammograms. Women without a visit to an oncologist or breast cancer surgeon during a year have particularly low rates of mammography. Improvements to surveillance care for breast cancer survivors may require active participation by primary care physicians and improvements in cancer survivorship programs by healthcare systems.

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Acknowledgments

This study was supported by a grant from the National Cancer Institute (R01 CA093772 R. Silliman, PI). A number of people assisted in the conduct of this study, including project managers, programmers, and medical record abstractors: Group Health—Linda Shultz, Kristin Delaney, Margaret Farrell-Ross, Mary Sunderland, Millie Magner, and Beth Kirlin; Meyers Primary Care Institute and Fallon Clinic—Jackie Fuller, Doris Hoyer, and Janet Guilbert; Henry Ford Health System—Sharon Hensley Alford, Karen Wells, Patricia Baker, and Rita Montague; HealthPartners—Maribet McCarty and Alex Kravchik; Kaiser Permanente Southern California—Julie Stern, Janis Yao, and Michelle McGuirel; and Lovelace Health Plan—Judity Hurley, Hans Petersen, and Melissa Roberts. Three of the authors (FW, VPQ, MUY) have received funding from pharmaceutical companies.

Conflict of interest

None disclosed.

Author information

Authors and Affiliations

  1. Meyers Primary Care Institute, Worcester, MA, USA

    Terry S. Field DSc

  2. University of Massachusetts Medical School, Worcester, MA, USA

    Terry S. Field DSc & Chyke Doubeni MD, MPH

  3. Fallon Community Health Plan, Worcester, MA, USA

    Terry S. Field DSc

  4. Fallon Foundation, Worcester, MA, USA

    Terry S. Field DSc

  5. Boston University School of Public Health, Boston, MA, USA

    Matthew P. Fox DSc, MPH, Timothy L. Lash DSc, MPH, Marianne N. Prout MD, MPH & Rebecca A. Silliman PhD, MD

  6. Group Health Center for Health Studies, Seattle, WA, USA

    Diana S. M. Buist PhD

  7. HealthPartners Research Foundation, Minneapolis, MN, USA

    Feifei Wei PhD

  8. Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Ann M. Geiger MPH, PhD

  9. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA

    Virginia P. Quinn PhD

  10. Geriatrics Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA

    Timothy L. Lash DSc, MPH & Rebecca A. Silliman PhD, MD

  11. Josephine Ford Cancer Center, Henry Ford Health System, Detroit, MI, USA

    Marianne Ulcickas Yood DSc

  12. Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA

    Marianne Ulcickas Yood DSc

  13. Lovelace Health Systems, Albuquerque, NM, USA

    Floyd J. Frost PhD

Authors
  1. Terry S. Field DSc
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  2. Chyke Doubeni MD, MPH
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  3. Matthew P. Fox DSc, MPH
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  4. Diana S. M. Buist PhD
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  5. Feifei Wei PhD
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  6. Ann M. Geiger MPH, PhD
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  7. Virginia P. Quinn PhD
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  8. Timothy L. Lash DSc, MPH
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  9. Marianne N. Prout MD, MPH
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  10. Marianne Ulcickas Yood DSc
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  11. Floyd J. Frost PhD
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  12. Rebecca A. Silliman PhD, MD
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Corresponding author

Correspondence to Terry S. Field DSc.

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Field, T.S., Doubeni, C., Fox, M.P. et al. Under Utilization of Surveillance Mammography among Older Breast Cancer Survivors. J GEN INTERN MED 23, 158–163 (2008). https://doi.org/10.1007/s11606-007-0471-2

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  • DOI: https://doi.org/10.1007/s11606-007-0471-2

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