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Med Care. 2012 Mar;50(3):270-6. doi: 10.1097/MLR.0b013e318244d294.

Health insurance and other factors associated with mammography surveillance among breast cancer survivors: results from a national survey.

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  • 1National Centers for Chronic Disease Prevention and Health Promotion, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. SSabatino@cdc.gov

Abstract

BACKGROUND:

Whether disparities in mammography surveillance among breast cancer survivors exist by health insurance type is unclear.

OBJECTIVES:

To determine the association of surveillance mammography with insurance and other factors among breast cancer survivors. DESIGN/PARTICIPANTS/MEASURES: We examined mammography within the prior year among 1511 breast cancer survivors aged 30 or older and ≥1 year after diagnosis from the 2000, 2003, 2005, and 2008 National Health Interview Surveys. Insurance included private (health maintenance organization/independent practice association, other, unspecified), Medicare+private, public only (Medicare+Medicaid, other Medicare, other public), and uninsured. Multivariable logistic regression was used to determine factors associated with mammography, including age, race/ethnicity, education, time since diagnosis, health status, insurance, income to poverty threshold ratios, having a usual provider, and survey year. Results are presented as predictive margins. For insurance, pairwise comparisons were used to compare Medicare+private versus other groups.

RESULTS:

Overall 75% reported a mammogram. Mammography reporting was lower for uninsured survivors and those with only public insurance versus Medicare+private or private (50% and 68% vs. 76% and 80%, respectively; P=0.001). In each insurance group, 20% to 50% reported not receiving a mammogram. After adjustment, use remained lower for women with only public insurance versus Medicare+private (71% vs. 78%, P=0.029). Age of at least 75 years, greater time since diagnosis, and no usual provider were associated with not reporting a mammogram.

CONCLUSIONS:

One in 4 breast cancer survivors did not report guideline-concordant mammography surveillance. Women with only public insurance were less likely than those with Medicare+private coverage to report a mammogram. Efforts to understand barriers and promote mammography among survivors are needed.

PMID:
22193416
[PubMed - indexed for MEDLINE]
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