Surveillance mammography for Medicaid/Medicare breast cancer patients.

BACKGROUND: Surveillance mammography for breast cancer survivors can detect recurrences early when treatment is most effective. We assessed the receipt of surveillance mammography for elderly breast cancer survivors considering their Medicaid and Medicare dual eligibility and minority status that may make them vulnerable to poor surveillance care.
METHODS: We analyzed Michigan Medicare and Medicaid data for patients, age 66 years or older, diagnosed with early stage breast cancer between 1997 and 2000. Using logistic regression and proportional hazards models, we identified individual and area level factors associated with patients' receipt and timeliness of surveillance mammography for up to 3 years post treatment.
RESULTS: In the first year post cancer treatment, patients who received breast conserving surgery (BCS) and radiation therapy were more likely to receive surveillance mammography than those treated with BCS alone (OR = 1.82; 95% CI = 1.48-2.24). Patients who received BCS and radiation treatment also had a greater probability of receiving surveillance mammography sooner than those treated with BCS alone (HR = 1.72; 95% CI = 1.56-1.89). Time from treatment to mammography was longer for older (80+ years) versus younger patients (HR = 0.55; 95% CI = 0.45-0.66) and for those with greater comorbidity burden (HR = 0.59; 95% CI = 0.43-0.81).
CONCLUSIONS: Regardless of race and dual eligibility, there is a greater likelihood for breast cancer patients who received BCS with radiation to receive surveillance mammography and to receive it sooner than for patients who were treated with BCS alone. IMPLICATIONS FOR CANCER SURVIVORS: Dual eligible, black, and elderly patients are less likely to receive radiation following BCS, thus disparities across the treatment and surveillance continuum need to be further investigated.