Older breast cancer survivors shared care study

Mammography rates better with shared care

If follow-up mammography is an indicator of quality breast cancer care, then older survivors who receive shared care–provided by both a primary care physician and a cancer specialist–are better cared for than those who don’t.

A study at the Medical College of Wisconsin Center for Patient Care and Outcomes Research in Milwaukee revealed that about two-thirds of elderly breast cancer survivors underwent shared care in the first three years after treatment, and that they had higher mammography rates in all three years (84, 81, and 78.6 percent, respectively) than survivors who saw only a specialist or generalist (not both). Mammography rates for the later group were only 76.3, 70.05 and 66 percent, respectively, for the three years of the study.

The team looked at National Cancer Institute Surveillance, Epidemiology, and End-Result (SEER) data, linked to U.S. Census and Medicare data to evaluate 3,828 older women diagnosed with either in situ, stage I or Stage II breast cancer in 1995. The routine follow-up care these women received was assessed for three years after their cancer was treated.

Disturbingly, the researchers also found that under-use of mammography was most common among women at greatest risk of recurrence: those treated with breast-conserving surgery without radiation, and those with stage II disease. The study appears in the online March 15, issue of Breast Cancer Research and Treatment.

While there are no major studies comparing breast cancer survivors undergoing surveillance mammography with those who don’t, screening mammography is thought to be critical for the early detection of either recurrent disease or of new, primary tumors.

“Previous studies have shown that over one-third of breast cancer survivors do not receive annual mammography after treatment, so we know that there are problems with the quality of follow-up care for survivors,” says co-author Kenneth Schellhase, M.D., M.P.H., assistant professor of family & community medicine. “However the best approach for delivering such care remains unclear. We wondered whether the specialty of the physician made a difference, so we evaluated mammography use among survivors followed by primary care physicians, cancer specialists, or both. Our results are encouraging that primary care physicians and specialists who cooperate in the care of breast cancer survivors can deliver better quality care.”

All women in the study were age 66 or older, and a majority was white and lived in urban areas The SEER Data covered five states and six metropolitan areas, representing 14 percent of the US population. Medicare claims data were used to measure each patient’s health care utilization, such as office visits (a total of 123,595 for the 3,828 women) or mammograms. U.S. Census files were used to estimate socioeconomic characteristics for study subjects and the American Medical Association Master File to determine the specialties of the 4,084 physicians involved.

Medical College student Ann Etim was first author of the study. This research was funded by the National Cancer Institute. Biostatistician Rodney Sparapani, M.S., and Lady Riders Professor in Breast Cancer Research Ann B. Nattinger, M.D., MPH, professor of medicine, chief of general internal medicine, and director of the Center for Patient Care and Outcomes Research, were co-investigators.