Many Breast Cancer Survivors Not Getting Recommended Mammograms

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Breast Cancer and Mammography

A new study finds use of annual mammography among breast cancersurvivors, who are at increased risk of a recurrence or a newmalignancy in the other breast, dropped off after a few years. Duringthe five year study period, only one in three women in this high-riskpopulation had received regular annual mammograms. Published in theJune 1, 2006 issue of CANCER, a peer-reviewed journal of the AmericanCancer Society, the study reveals the most significant factorspredicting who got screened included being seen by a gynecologist orprimary care physician and having been treated with breast conservingsurgery.

There are more than 2.3 million women in the United States whohave been treated for breast cancer. Women with a history of breastcancer face a three-fold increased risk of a malignancy in the otherbreast. Recommendations for follow-up of these women include annualmammography for early identification of subsequent cancers. In thegeneral population, mammography has been demonstrated to be effectiveat reducing mortality. In breast cancer survivors, mammography has beenshown to identify tumors at early stages, when treatment is moresuccessful.

Existing studies show that mammography is underutilized by thegeneral population and by Medicare beneficiaries who survived breastcancer. However, little is known about how often survivors with managedcare health insurance are screened and how non-financial factors impactits use.

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Chyke A. Doubeni, M.D., M.P.H. of the University ofMassachusetts Medical School and colleagues reviewed mammography use in797 women over the age of 55 who had been treated for breast cancer.Their objective was to identify patterns of mammography utilization inwomen when health insurance coverage is not a factor.

The researchers found that in the first year after treatment,80 percent of women had received a screening mammogram. At the fifthyear of follow-up, only 63 percent had received a mammogram that year,and only one in three women (33 percent) had received a mammogram eachyear over the five years.

Women who were being cared for by their gynecologist orprimary care physician were the most likely to have mammograms in thefifth year. While the impact of physician specialty in mammographyscreening has been demonstrated in the general population, this is thefirst report of this association in breast cancer survivors. Inaddition, older women, particularly those with other medicalconditions, and those with late-stage tumors were significantly lesslikely to have a mammogram.

The study indicates regular mammography for breast cancersurvivors declines steadily within five years of treatment. "Effortsare needed to increase awareness among healthcare providers and breastcancer survivors on the value of follow-up mammography," say theauthors.

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