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Receipt of Screening Mammography Associated With Improved Outcomes Among Patients With Breast Cancer
Findings from a recent study suggest that nonreceipt of screening mammography among insured women diagnosed with breast cancer may be associated with late-stage disease and mortality, indicating that an increase of screening mammography could improve breast cancer outcomes (J Natl Compr Canc Netw. 2021;jnccn20426. doi:10.6004/jnccn.2020.7801).
Marissa B Lawson, MD, Department of Radiology, University of Washington School of Medicine, Seattle, Washington, and colleagues aimed to identify factors associated with receipt of screening mammography by insured women before breast cancer diagnosis, and outcomes that followed.
Women diagnosed with breast cancer between 2007 and 2017 were identified through claims data from commercial and federal payers linked to a regional SEER registry. Receipt of screening mammography within 1 year before diagnosis was determined among participants.
Patient and tumor characteristics were identified through the SEER registry, and associations of patient and tumor characteristics with late-stage disease and nonreceipt of mammography were analyzed through multivariable logistic regression models.
Socioeconomic deprivation scores were based on the patient’s residential address. Multivariable Cox proportional hazards models were used to determine predictors of subsequent mortality.
In total, 4853 (69%) of the 7047 women in this study received screening mammography before breast cancer diagnosis. Participants with no mammography had a higher proportion of late-stage disease, totaling 34%, compared to 10% of women who received mammography. Those with no mammography also had higher 5-year mortality (18% vs 6%).
Results from the multivariable logistic regression models revealed that late-stage disease was associated with nonreceipt of mammography (odds ratio, 4.35). The multivariable Cox proportional hazards models revealed that nonreceipt of mammography was associated with increased risk of mortality (hazard ratio, 2), independent of late-stage disease at diagnosis (hazard ratio, 5), with a Charlson comorbidity index score of 1 or higher (hazard ratio, 2.75), and negative estrogen receptor or progesterone receptor status.
Those who did not receive mammography were often younger in age than those who did receive mammography (40–49 vs 50–59 years), and were associated with increased socioeconomic deprivation (odds ratio, 1.05 per decile increase).
“In a cohort of insured women diagnosed with breast cancer, nonreceipt of screening mammography was significantly associated with late-stage disease and mortality, suggesting that interventions to further increase uptake of screening mammography may improve breast cancer outcomes,” concluded Dr Lawson and colleagues.—Marta Rybczynski
