Use of Breast Cancer Screening and Its Association with Later Use of Preventive Services among Medicare Beneficiaries

Radiology. 2018 Sep;288(3):660-668. doi: 10.1148/radiol.2018172326. Epub 2018 Jun 5.

Abstract

Purpose To retrospectively assess whether there is an association between screening mammography and the use of a variety of preventive services in women who are enrolled in Medicare. Materials and Methods U.S. Medicare claims from 2010 to 2014 Research Identifiable Files were reviewed to retrospectively identify a group of women who underwent screening mammography and a control group without screening mammography in 2012. The screened group was divided into positive versus negative results at screening, and the positive subgroup was divided into false-positive and true-positive findings. Multivariate logistic regression models and inverse probability of treatment weighting were used to examine the relationship between screening status and the probabilities of undergoing Papanicolaou test, bone mass measurement, or influenza vaccination in the following 2 years. Results The cohort consisted of 555 705 patients, of whom 185 625 (33.4%) underwent mammography. After adjusting for patient demographics, comorbidities, geographic covariates, and baseline preventive care, women who underwent index screening mammography (with either positive or negative results) were more likely than unscreened women to later undergo Papanicolaou test (odds ratio [OR], 1.49; 95% confidence interval: 1.40, 1.58), bone mass measurement (OR, 1.70; 95% confidence interval: 1.63, 1.78), and influenza vaccine (OR, 1.45; 95% confidence interval: 1.37, 1.53). In women who had not undergone these preventive measures in the 2 years before screening mammography, use of these three services after false-positive findings at screening was no different than after true-negative findings at screening. Conclusion In beneficiaries of U.S. Medicare, use of screening mammography was associated with higher likelihood of adherence to other preventive guidelines, without a negative association between false-positive results and cervical cancer screening.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Absorptiometry, Photon / statistics & numerical data*
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / diagnostic imaging*
  • Early Detection of Cancer / statistics & numerical data
  • Female
  • Humans
  • Influenza Vaccines / therapeutic use*
  • Mammography / statistics & numerical data*
  • Mass Screening / statistics & numerical data
  • Medicare*
  • Papanicolaou Test / statistics & numerical data*
  • Primary Prevention / methods
  • Primary Prevention / statistics & numerical data
  • Retrospective Studies
  • United States

Substances

  • Influenza Vaccines