Older breast cancer survivors shared care study

If follow-up mammography is an indicator of quality breast cancer care, then older survivors who receive shared care--provided by both a primary care physician and a cancer specialist--are better cared for than those who don't.

A study at the Medical College of Wisconsin Center for Patient Care and Outcomes Research in Milwaukee revealed that about two-thirds of elderly breast cancer survivors underwent shared care in the first three years after treatment, and that they had higher mammography rates in all three years (84, 81, and 78.6 percent, respectively) than survivors who saw only a specialist or generalist (not both). Mammography rates for the later group were only 76.3, 70.05 and 66 percent, respectively, for the three years of the study.

The team looked at National Cancer Institute Surveillance, Epidemiology, and End-Result (SEER) data, linked to U.S. Census and Medicare data to evaluate 3,828 older women diagnosed with either in situ, stage I or Stage II breast cancer in 1995. The routine follow-up care these women received was assessed for three years after their cancer was treated.

Disturbingly, the researchers also found that under-use of mammography was most common among women at greatest risk of recurrence: those treated with breast-conserving surgery without radiation, and those with stage II disease. The study appears in the online March 15, issue of Breast Cancer Research and Treatment.

While there are no major studies comparing breast cancer survivors undergoing surveillance mammography with those who don't, screening mammography is thought to be critical for the early detection of either recurrent disease or of new, primary tumors.

"Previous studies have shown that over one-third of breast cancer survivors do not receive annual mammography after treatment, so we know that there are problems with the quality of follow-up care for survivors," says co-author Kenneth Schellhase, M.D., M.P.H., assistant professo

Contact: Eileen LaSusa
Medical College of Wisconsin

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