Surveillance mammography among female Department of Defense beneficiaries

A study by race and ethnicity

Authors

  • Lindsey Enewold PhD, MPH,

    Corresponding author
    1. Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Rockville, Maryland
    2. National Cancer Institute, National Institutes of Health, Bethesda, Maryland
    • Corresponding author: Lindsey Enewold, PhD, MPH, NCI Shady Grove, DCCPS, Applied Research Program (ARP), Health Services Economics Branch, 9609 Medical Center Drive, Room 3E506, Bethesda, MD 20892-9762; Fax: (240) 276-7906; enewoldlr@mail.nih.gov

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  • Katherine A. McGlynn PhD, MPH,

    1. National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Shelia H. Zahm ScD,

    1. National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Ismail Jatoi MD, PhD,

    1. Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
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  • William F. Anderson MD, MPH,

    1. National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Abegail A. Gill MPH,

    1. Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Rockville, Maryland
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  • Craig D. Shriver MD,

    1. John P. Murtha Cancer Center and Breast Center and General Surgery Services, Walter Reed National Military Medical Center, Bethesda, Maryland
    2. Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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  • Kangmin Zhu MD, PhD

    1. Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Rockville, Maryland
    2. Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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  • The opinions and assertions expressed in this article represent the private views of the authors and do not reflect the official views of the US Departments of the Army, Navy, or Defense; the National Cancer Institute; or the US government. Nothing in the presentation implies any Federal/Department of Defense/Department of the Navy endorsement.

Abstract

BACKGROUND

Annual surveillance mammography is recommended after a diagnosis of breast cancer. Previous studies have suggested that surveillance mammography varies by demographics and initial tumor characteristics, which are related to an individual's access to health care. The Military Health System of the Department of Defense provides beneficiaries with equal access health care 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 variations in the use of surveillance mammography during 3 periods of 12 months each, beginning 1 year after diagnosis adjusting for demographic, tumor, and health characteristics.

RESULTS

The rate of overall surveillance mammography decreased from 70% during the first year to 59% during the third year (P < .01). Although there was an overall tendency for surveillance mammography to be higher among minority women compared with non-Hispanic white women, after adjusting for covariates, the difference was found to be significant only during the first year among black women (odds ratio [OR], 1.46; 95% confidence interval [95% CI], 1.10-1.95) and the second year among Asian/Pacific Islander (OR, 2.29; 95%CI, 1.52-3.44) and Hispanic (OR, 1.92; 95%CI, 1.17-3.18) women. When stratified by age at diagnosis and type of breast cancer surgery performed, significant racial differences tended to be observed among younger women (aged < 50 years) and only among women who had undergone mastectomies.

CONCLUSIONS

Minority women were equally or more likely than non-Hispanic white women to receive surveillance mammography within the Military Health System. The racial disparities in surveillance mammography reported in other studies were not observed in a system with equal access to health care. Cancer 2013;119:3531–3538.. © 2013 American Cancer Society.

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