Article

Under utilization of surveillance mammography among older breast cancer survivors.

Meyers Primary Care Institute, Worcester, MA 01605, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 03/2008; 23(2):158-63. DOI: 10.1007/s11606-007-0471-2
Source: PubMed

ABSTRACT 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.
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.
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).
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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    • "woman-years [11]. Despite recommendations for annual mammography put forth by entities, such as the National Comprehensive Cancer Network, the American Cancer Society, and the American College of Radiology, breast surveillance has been shown to be low among women who are elderly, black, had late-stage disease, had mastectomy or breast conserving surgery (BCS) without radiation, did not see a physician, and had more comorbid illnesses [12] [13] [14] [15] [16]. Also, adherence to surveillance mammography diminishes over time, with one "
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    ABSTRACT: Background. Patterns of surveillance among breast cancer survivors are not well characterized and lack evidence-based practice guidelines, particularly for imaging modalities other than mammography. We characterized breast imaging and related biopsy longitudinally among breast cancer survivors in relation to women's characteristics. Methods. Using data from a state-wide (New Hampshire) breast cancer screening registry linked to Medicare claims, we examined use of mammography, ultrasound (US), magnetic resonance imaging (MRI), and biopsy among breast cancer survivors. We used generalized estimating equations (GEE) to model associations of breast surveillance with women's characteristics. Results. The proportion of women with mammography was high over the follow-up period (81.5% at 78 months), but use of US or MRI was much lower (8.0%—first follow-up window, 4.7% by 78 months). Biopsy use was consistent throughout surveillance periods (7.4%–9.4%). Surveillance was lower among older women and for those with a higher stage of diagnosis. Primary therapy was significantly associated with greater likelihood of breast surveillance. Conclusions. Breast cancer surveillance patterns for mammography, US, MRI, and related biopsy seem to be associated with age, stage, and treatment, but need a larger evidence-base for clinical recommendations.
    10/2012; 2012:347646. DOI:10.1155/2012/347646
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    • "Quite similar to the general population (Cui et al., 2007; Cummings, Whetstone, Shende, & Weismiller, 2000; Goodwin, Visintainer, Facelle, & Falvo, 2006; Williams, Lindquist, Sudore, Covinsky, & Walter, 2008) factors that predict mammography utilization in survivors of breast cancer and Hodgkin disease include visits to the oncologist (Field et al., 2008), gynecologist (Doubeni et al., 2006), or primary care physician (Doubeni et al., 2006), having health insurance (Bober, Park, Schmookler, Medeiros Nancarrow, & Diller, 2007), physician support (Bober et al., 2007), worry about breast cancer (Bloom, Stewart, & Hancock, 2006), older age (Bloom et al., 2006), and higher education and income (Breen, Yarbroff, & Meissner, 2007). Childhood cancer survivors who are least likely to report receiving routine mammography are younger and express a lack of concern for future health issues (Yeazel et al., 2004). "
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    ABSTRACT: Purpose/Objectives: To identify treatment, intrapersonal, and provider factors that influence childhood cancer survivors' adherence to recommended mammography screening.Design: Secondary analysis of data derived from three consecutive surveys within the Childhood Cancer Survivor Study.Sample: Female childhood cancer survivors: N = 335, X age = 30.92, X years after diagnosis = 21.79.Methods: T tests and structural equation modeling.Main Research Variables: Mammogram recency, health concerns, affect, motivation, and survivor-provider interaction.Findings: Forty-three percent of the variance was explained in mammogram recency. Survivors most likely to follow the recommended mammogram schedule were directly influenced by cancer treatment exposure to mantle radiation (p = 0.01), less intrinsic motivation (p = 0.01), positive affect (p = 0.05), recent visits to an oncology clinic (p = 0.01), discussion of subsequent cancer risks with a physician (p = 0.001), perceptions of more severe late effects (p = 0.05), age (40 years or older) (p </= 0.001), and a print media intervention detailing breast cancer risks and follow-up strategies.Conclusions: Perceived symptoms, motivation, affect, provider influences, readiness for medical follow-up, and knowledge of treatment exposures are potential modifiable targets for intervention to support mammography screening in childhood cancer survivors at risk.Implications for Nursing: (a) Provide written summaries of treatment exposures and recommended schedule of mammography screening at the end of cancer treatment and throughout follow-up; (b) identify and address survivor symptoms and concerns that may negate screening; and (c) enhance motivation for screening by tailoring personal risk information to health concerns, affect, and readiness for follow-up.
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