Underutilization of mammography in older breast cancer survivors

BACKGROUND. Annual mammography is recommended for all breast cancer survivors. OBJECTIVES. TO elucidate mammography use among older survivors of breast cancer and to explore determinants of such use. RESEARCH DESIGN. Retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare claims. SUBJECTS. A cohort of 3885 breast cancer survivors aged greater than or equal to 65 years diagnosed with early-stage breast cancer in the United States in 1991. MEASURES. Medicare mammogram claims during the 2-year period following initial breast cancer treatment. RESULTS. Overall, 62% of the cohort underwent annual mammography, 23% underwent mammography in 1 of 2 years, and 15% had no mammography claim in the 2 years evaluated. Twenty-two percent of the women who underwent breast-conserving surgery (BCS) without radiotherapy had no mammogram in the a-year period evaluated, compared with 17% of those who underwent mastectomy and 4% of those who underwent BCS with radiotherapy. In multivariate analyses controlling for age, cancer stage, and other patient factors, the use of annual mammography was significantly lower among women treated with mastectomy or BCS without radiotherapy than among women treated with BCS with radiotherapy. CONCLUSIONS. Mammography is underused in the follow-up care of older breast cancer survivors. Underuse is of particular concern in women treated with BCS without radiotherapy because of the high risk of local disease recurrence. It is unknown whether poorer follow-up care contributes to the previously described lower rate of long-term survival among women who received this therapy.