Trends in Annual Surveillance Mammography Participation Among Breast Cancer Survivors From 2004 to 2016

Authors:
Kathryn P. Lowry Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington;

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Katherine A. Callaway Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts;

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Janie M. Lee Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington;

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Fang Zhang Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts;

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Dennis Ross-Degnan Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts;

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J. Frank Wharam Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts;

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Karla Kerlikowske Department of Medicine, and
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California;

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Karen J. Wernli Kaiser Permanente Washington Health Research Institute, Seattle, Washington;

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Allison W. Kurian Department of Medicine, Stanford University School of Medicine, Palo Alto, California;

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Louise M. Henderson Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; and

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Natasha K. Stout Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts;
Harvard Medical School, Boston, Massachusetts.

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Background: Annual mammography is recommended for breast cancer survivors; however, population-level temporal trends in surveillance mammography participation have not been described. Our objective was to characterize trends in annual surveillance mammography participation among women with a personal history of breast cancer over a 13-year period. Methods: We examined annual surveillance mammography participation from 2004 to 2016 in a nationwide sample of commercially insured women with prior breast cancer. Rates were stratified by age group (40–49 vs 50–64 years), visit with a surgical/oncology specialist or primary care provider within the prior year, and sociodemographic characteristics. Joinpoint models were used to estimate annual percentage changes (APCs) in participation during the study period. Results: Among 141,672 women, mammography rates declined from 74.1% in 2004 to 67.1% in 2016. Rates were stable from 2004 to 2009 (APC, 0.1%; 95% CI, −0.5% to 0.8%) but declined 1.5% annually from 2009 to 2016 (95% CI, −1.9% to −1.1%). For women aged 40 to 49 years, rates declined 2.8% annually (95% CI, −3.4% to −2.1%) after 2009 versus 1.4% annually in women aged 50 to 64 years (95% CI, −1.9% to −1.0%). Similar trends were observed in women who had seen a surgeon/oncologist (APC, −1.7%; 95% CI, −2.1% to −1.4%) or a primary care provider (APC, −1.6%; 95% CI, −2.1% to −1.2%) in the prior year. Conclusions: Surveillance mammography participation among breast cancer survivors declined from 2009 to 2016, most notably among women aged 40 to 49 years. These findings highlight a need for focused efforts to improve adherence to surveillance and prevent delays in detection of breast cancer recurrence and second cancers.

Submitted January 26, 2021; final revision received June 30, 2021; accepted for publication July 8, 2021.

Author contributions: Study concept: All authors. Data curation: Callaway, Stout. Formal analysis: Lowry, Callaway, Stout. Funding acquisition: Lee, Zhang, Ross-Degnan, Wharam, Kerlikowske, Wernli, Henderson, Stout. Methodology: Lowry, Callaway, Zhang, Ross-Degnan, Wharam, Stout. Project administration: Stout. Resources: Wharam, Stout. Software: Callaway, Stout. Supervision: Stout. Visualization: All authors. Writing – original draft: Lowry, Callaway, Stout. Writing – review and editing: All authors.

Disclosures: Dr. Lowry has disclosed receiving grant/research support from GE Healthcare, Inc. Dr. Kerlikowske has disclosed serving as an unpaid consultant for Grail. Dr. Lee has disclosed receiving grant/research support, consultant fees, and nonfinancial support from GE Healthcare. Dr. Wernli has disclosed receiving grant/research support from NCI and the Patient-Centered Outcomes Research Institute. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the NCI of the NIH under award number R01 CA207373 (N.K. Stout).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Correspondence: Kathryn P. Lowry, MD, Department of Radiology, University of Washington, 1144 Eastlake Avenue East, LG-215, Seattle, WA 98109. Email: kplowry@uw.edu

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