Breast Cancer Research and Treatment

, Volume 143, Issue 3, pp 541–550 | Cite as

Factors associated with long-term adherence to annual surveillance mammography among breast cancer survivors

  • Heidi S. Wirtz
  • Denise M. Boudreau
  • Julie R. Gralow
  • William E. Barlow
  • Shelly Gray
  • Erin J. A. Bowles
  • Diana S. M. Buist
Epidemiology

Abstract

Clinical practice guidelines recommend yearly surveillance mammography for breast cancer survivors, yet many women do not receive this service. The objective of this study was to evaluate factors related to long-term surveillance mammography adherence among breast cancer survivors. We conducted a retrospective cohort study among women ≥18 years, diagnosed with incident stage I or II breast cancer between 1990 and 2008. We used medical record and administrative health plan data to ascertain covariates and receipt of surveillance mammography for up to 10 years after completing breast cancer treatment. Surveillance included post-diagnosis screening exams among asymptomatic women. We used multivariable repeated measures generalized estimating equation regression models to estimate odds ratios and robust 95 % confidence intervals to examine factors related to the annual receipt of surveillance mammography. The analysis included 3,965 women followed for a median of six surveillance years; 79 % received surveillance mammograms in year 1 but decreased to 63 % in year 10. In multivariable analyses, women, who were <40 years or 80+ years of age (compared to 50–59 years), current smokers, had greater comorbidity, were diagnosed more recently, had stage II cancer, or were treated with mastectomy or breast conserving surgery without radiation, were less likely than other women to receive surveillance mammography. Women with outpatient visits during the year to primary care providers, oncologists, or both were more likely to undergo surveillance. In this large cohort study of women diagnosed with early-stage invasive breast cancer, we found that important subgroups of women are at high risk for non-adherence to surveillance recommendations, even among younger breast cancer survivors. Efforts should be undertaken to actively engage breast cancer survivors in managing long-term surveillance care.

Keywords

Breast cancer Cancer survivors Surveillance Mammography Survivorship care 

Supplementary material

10549_2013_2816_MOESM1_ESM.doc (310 kb)
Supplementary material 1 (DOC 310 kb)

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Heidi S. Wirtz
    • 1
  • Denise M. Boudreau
    • 1
    • 2
  • Julie R. Gralow
    • 3
  • William E. Barlow
    • 4
    • 5
  • Shelly Gray
    • 1
  • Erin J. A. Bowles
    • 2
  • Diana S. M. Buist
    • 2
    • 6
    • 7
  1. 1.Department of PharmacyUniversity of WashingtonSeattleUSA
  2. 2.Group Health Research InstituteSeattleUSA
  3. 3.Seattle Cancer Care AllianceSeattleUSA
  4. 4.Cancer Research and BiostatisticsSeattleUSA
  5. 5.Department of BiostatisticsUniversity of WashingtonSeattleUSA
  6. 6.Department of EpidemiologyUniversity of WashingtonSeattleUSA
  7. 7.Department of Health ServicesUniversity of WashingtonSeattleUSA

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