J. Yu1, N. P. Carlsson1, G. A. Colditz1, M. S. Goodman1, S. Chang1, J. A. Margenthaler1 1Washington University,Surgery,St. Louis, MO, USA
Introduction:
Over 2 million women currently live with breast cancer in the United States, and the annual incidence of more than 200,000 new cases is predicted to remain constant. Secondary prevention of breast cancer with screening mammography has become the standard of care, but recent updates in recommended screening mammography frequencies have ignited substantial controversy both among physicians and from a societal perspective. To better understand the potential impact on patients, we assess guideline adherence in a retrospective cohort of commercially-insured U.S. women diagnosed with breast cancer.
Methods:
Using the Truven Health Analytics|MarketScan®|Database from 2006-2012, we conducted a retrospective review of screening mammography frequencies in women aged 40-60 during the 5 years prior to primary breast cancer diagnosis, excluding ductal carcinoma in situ (DCIS), in 2011-2012. Patient demographics, family history, and clinical characteristics were extracted from the database, and screening adherence was defined as annual (<14 months) and biennial (<26 months). Unadjusted and multivariable analyses were performed, with two-sided statistical testing. Statistical significance was determined using α =0.05.
Results:
Of 1,876 women diagnosed with breast cancer in 2011-2012, mean age at diagnosis was 53.7±4.3 years, and patients underwent an average of 5.2±2.4 mammograms (2.7±1.7 screening, 2.0±1.4 diagnostic) prior to diagnosis. Only 16.4% were adherent to annual screening vs. 51.6% adherent to at least biennial screening. In the adjusted multivariable analysis, odds of adherence to either annual or biennial screening were significantly increased with family history of breast cancer (OR=1.74 [95% CI=1.30-2.32]; OR=1.50, [95% CI=1.19-1.89]), decreased with higher Klabunde Charlson comorbidity score (OR=0.89 [95% CI=0.82-0.97]; OR=0.92 [95% CI=0.87-0.97]), and unaffected by insurance provider (OR=0.77 [95% CI=0.57-1.0]; OR=1.14 [95% CI=0.91-1.43]) or geographic region (OR=0.98 [95%CI=0.68-1.40]; OR=1.08 [95% CI=0.82-1.42]).
Conclusion:
Biennial screening mammography recommendations will likely result in higher rates of guideline adherence. In this retrospective cohort, more than triple the number of women included were adherent to biennial vs. annual screening; even so, nearly 50% of commercially-insured U.S. women diagnosed with breast cancer in 2011-2012 were not adherent to even biennial screening prior to diagnosis. Further assessments of resource utilization and long-term outcomes will be critical to determine appropriate population health intervention methods to increase screening compliance.