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Improving breast cancer outcome via primary care visits

Robin Wulffson MD's picture
breast cancer, early diagnosis, survival, primary care, preventive healthcare

According to the Centers for Disease Control and Prevention (CDC), in the United States in 2008, 210,203 women were diagnosed with breast cancer, and 40,589 women died from the disease. (2008 is the latest year that statistics are available). Except for skin cancer, breast cancer is the most common cancer among American women. The CDC supports breast cancer surveillance and research; it notes that early diagnosis increases the chance of long-term survival.

A new study published in the September/October issue of the Annals of Family Medicine reported that women who regularly visited their primary care physicians were more likely to have their breast cancer diagnosed early.

The researchers accessed data from the Surveillance Epidemiology and End Results (SEER)-Medicare database to evaluate the association between primary care and breast cancer outcomes. The study group comprised 105,105 female Medicare beneficiaries with a diagnosis of breast cancer in SEER registries during the years 1994–2005. The researchers examined the total number of office visits to primary care physicians and non–primary care physicians in a 24-month period before cancer diagnosis. For women with invasive cancers, they examined the odds of diagnosis of late-stage disease, according to the American Joint Commission on Cancer (AJCC) (stages III and IV vs. stages I and II), and survival. They also explored whether including noninvasive cancers, such as ductal carcinoma in situ (DCIS), would alter results and whether prior mammography was of value.

The investigators found that primary care physician visits were associated with improved breast cancer outcomes, including greater use of mammography, reduced odds of late-stage diagnosis, and lower breast cancer overall mortality. Prior mammography (and resultant earlier stage diagnosis) facilitated these associations in part, but not completely. The researchers found similar results for women who visited non–primary care physicians. The results were similar when women with DCIS were included in the analysis.

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Women who made 10 or more office visits during the 24 months before being diagnosed with cancer were 50% less likely to receive a diagnosis of late-stage disease. In addition, breast-cancer-related mortality was 41% lower and overall mortality was 27% lower in these women than in those who had made one or no visits. The investigators noted that these improved outcomes can be partly explained by the greater use of mammography, resulting in earlier-stage diagnosis. The odds of having had a previous mammogram rose when more frequent office visits were mad to a primary care physician. Women who made 10 visits were four times more likely to have had a previous mammogram than those reporting the lowest number of visits. The odds of a having a previous mammogram also increased with a higher number of visits to a physician other than a primary care physician; more than 10 visits was associated with a 3.3 times greater odds of having a previous mammogram.

The researchers concluded that Medicare beneficiaries with breast cancer had better outcomes if they made greater use of a primary care physician’s ambulatory services. They noted that their findings suggest adequate primary medical care may be an important factor in achieving optimal breast cancer outcomes.

Take home message:
This study points to the advantage of regularly visiting a healthcare provider for preventive healthcare rather than waiting until symptoms are present. Early diagnosis is of value for the diagnosis of any healthcare problem such as breast cancer, hypertension, and type 2 diabetes.

Reference: Annals of Family Medicine

See also:
Delivering a large infant more than doubles breast cancer risk
Reduce your breast cancer risk with exercise
FDA accelerates drug approval for patients with aggressive breast cancers