Background: The purpose of this study was to determine factors associated with receipt of screening mammography by insured women before breast cancer diagnosis, and subsequent outcomes. Patients and Methods: Using claims data from commercial and federal payers linked to a regional SEER registry, we identified women diagnosed with breast cancer from 2007 to 2017 and determined receipt of screening mammography within 1 year before diagnosis. We obtained patient and tumor characteristics from the SEER registry and assigned each woman a socioeconomic deprivation score based on residential address. Multivariable logistic regression models were used to evaluate associations of patient and tumor characteristics with late-stage disease and nonreceipt of mammography. We used multivariable Cox proportional hazards models to identify predictors of subsequent mortality. Results: Among 7,047 women, 69% (n=4,853) received screening mammography before breast cancer diagnosis. Compared with women who received mammography, those with no mammography had a higher proportion of late-stage disease (34% vs 10%) and higher 5-year mortality (18% vs 6%). In multivariable modeling, late-stage disease was most associated with nonreceipt of mammography (odds ratio [OR], 4.35; 95% CI, 3.80–4.98). The Cox model indicated that nonreceipt of mammography predicted increased risk of mortality (hazard ratio [HR], 2.00; 95% CI, 1.64–2.43), independent of late-stage disease at diagnosis (HR, 5.00; 95% CI, 4.10–6.10), Charlson comorbidity index score ≥1 (HR, 2.75; 95% CI, 2.26–3.34), and negative estrogen receptor/progesterone receptor status (HR, 2.09; 95% CI, 1.67–2.61). Nonreceipt of mammography was associated with younger age (40–49 vs 50–59 years; OR, 1.69; 95% CI, 1.45–1.96) and increased socioeconomic deprivation (OR, 1.05 per decile increase; 95% CI, 1.03–1.07). Conclusions: In a cohort of insured women diagnosed with breast cancer, nonreceipt of screening mammography was significantly associated with late-stage disease and mortality, suggesting that interventions to further increase uptake of screening mammography may improve breast cancer outcomes.
Submitted August 15, 2020; final revision received December 20, 2020; accepted for publication December 21, 2020. Published online July 30, 2021.
Disclosures: Dr. C.I. Lee has disclosed receiving grant/research support from and serves on a data safety monitoring board for GRAIL, Inc., and receives royalties from McGraw Hill, Inc., Wolters Kluwer, and Oxford University Press. Mr. Hippe has disclosed receiving grant/research support from GE Healthcare, Philips Healthcare, Canon Medical Systems USA, and Siemens Healthineers. Dr. J.M. Lee has disclosed receiving grant/research support from GE Healthcare. The remaining authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.
Funding: Research reported in this publication was supported by the NCI of the NIH under award number P30 CA015704-43 (J.M. Lee).
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Correspondence: Janie M. Lee, MD, MSc, Seattle Cancer Care Alliance, 1144 Eastlake Avenue East, LG2-200, Seattle, WA 98109. Email: email@example.com
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