Older Breast Cancer Survivors Less Likely to Have Follow-up Mammograms

Medical College of Wisconsin researchers report that older breast cancer survivors are less likely to get annual mammograms, which are recommended for all breast cancer survivors to detect local recurrence or a second primary cancer. The use of annual surveillance mammography by older breast cancer survivors is lower than expected and much lower in older patients who have undergone breast conserving surgery (BCS) without radiation therapy.

"Use of surveillance mammography among women who have undergone BCS without radiation treatment is of particular interest because their rates of local recurrence of cancer are reported as high as 35 percent," said study authors Marilyn Schapira, MD, MPH and Ann Nattinger, MD, MPH. The study followed national tumor registry and Medicare data for two years on 3,885 American women over the age of 64 who were diagnosed with early-stage breast cancer in 1991. It concludes that mammography compliance promotion efforts should target older breast cancer survivors in addition to the general population.

Average age of the study subjects was 73.5 years and 90 percent had invasive breast cancer (stage I or II) at diagnosis. Approximately 91 percent of the group were white and four percent were African Americans. Sixty-three percent underwent mastectomy, 22 percent underwent breast conserving surgery with radiation and 15 percent underwent breast conserving surgery without radiation. Of the 1,451 women who underwent BCS, 41 percent did not receive radiation therapy.

Overall, 62 percent of study participants had a mammogram each year during the two-year study period, 23 percent had only one and 15 percent had none. Of the women who underwent BCS without radiation therapy, 22 percent had no follow-up mammogram, compared with only four percent of the women who underwent BCS with radiation. African American women and women of older age or lower educational status were also less likely to undergo annual mammography.

When controlling for factors such as age, cancer stage and other patient factors, the use of mammography was significantly lower among both women treated with mastectomy or BCS without radiation therapy than among women treated with BCS with radiation therapy.

The work by Drs. Schapira and Nattinger appeared in the journal Medical Care with Timothy McAuliffe, PhD as co-author.

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