Surveillance mammography among female Department of Defense beneficiaries

Abstract

Background Annual surveillance mammography is recommended after breast cancer diagnosis. Previous studies have suggested that surveillance mammography varies by demographics and initial tumor characteristics, which are related to access to healthcare. The Department of Defense's Military Health System (MHS) provides beneficiaries with equal healthcare access and thus offers an excellent opportunity to assess whether racial differences in surveillance mammography persist when access to care is equal. Methods Among female beneficiaries with a history of breast cancer logistic regression was used to assess racial/ethnic variation in surveillance mammography during three 12-month periods, beginning one year after diagnosis adjusting for demographic, tumor and health characteristics. Results Overall surveillance mammography decreased from 70% during the first year to 59% during the third year (p<0.01). Although there was an overall tendency for surveillance mammography to be higher among minority women compared to non-Hispanic white women, after adjusting for covariates, the difference was significant only during the first year among blacks (odds ratio (OR)=1.46; 95% Confidence Interval (CI)=1.10-1.95) and the second year among Asian Pacific Islanders (OR=2.29; 95%CI=1.52-3.44) and Hispanics (OR=1.92; 95%CI=1.17-3.18). When stratified by age at diagnosis and type of breast cancer surgery, significant racial differences tended to be observed among younger women (<50 years) and only among women who had mastectomies. Conclusion Minority women were equally or more likely than non-Hispanic white women to receive surveillance mammography within the MHS. The racial disparities in surveillance mammography reported in other studies were not observed in a system with equal access to care.

Racial disparities in risk of second breast tumors after ductal carcinoma in situ

“…Whether the elevated risk of contralateral DCIS among Asian/PI women resulted from their greater use of surveillance mammography is unknown. Among breast cancer patients with equal access to health care, Asians/PIs were more likely than whites to undergo surveillance mammography [31]. However, lower use of mammography was found among older Asians/PIs compared to their white counterparts [32].…”

Diabetes and Overall Survival among Breast Cancer Patients in the U.S. Military Health System

“…It was categorized as ‘yes’ if it was identified six months or more after a previous mammogram among women. If a mammogram was received two months prior to a diagnosis of a breast mass or other breast symptom, it might be diagnostic and thus was not considered as surveillance procedures 35 . Recurrence was defined based on the CCR definition and supplemented with information obtained from MDR 36 .…”

The Challenges of Screening Mammography in Racial/Ethnic Minority Populations in the United States: A mini-review and observations from a predominantly Hispanic community

“…However, providing more equal access to healthcare and screening resources has the potential to improve these disparities. In the Department of Defense Healthcare System, an equal-access model of healthcare with standard screening practices, the racial/ethnic differences in utilization of screening mammography are not observed, and survival from early stage breast cancer is not different between black and white women 31 , 32 .…”