Emerging research suggests that prior mammography screening within five years of breast cancer diagnosis for seniors significantly reduces the risks of later-stage diagnosis and breast cancer-specific mortality.
For the study, recently published in JAMA Network Open, researchers reviewed data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database for 13,028 women who had screening mammography-detected breast cancer. Over 77 percent of the cohort had at least one mammography screening in a five-year period prior to diagnosis and over 69 percent were in their 70s, according to the study. The researchers also noted that over 29 percent were diagnosed with later-stage (T2+ or N1+) disease.
Multivariable analysis revealed that women having at least one mammography screening in the five years prior to diagnosis had a 54 percent lower risk of a later-stage presentation at diagnosis. The study authors found that these women also had a 36 percent lower risk of breast cancer-specific death.
In comparison to seniors who had one mammography screening in the five years prior to diagnosis, researchers noted that senior women who had three or four screenings during that period had a 37 percent lower risk of breast cancer-specific mortality.
“ … We found that routine breast cancer screening, as defined by having a history of 1 or more negative screenings within 5 years prior to breast cancer diagnosis, was associated with almost half the odds of being diagnosed with later-stage diseases and two-thirds the hazard of breast cancer–specific mortality. … These results support the potential benefit of continued routine screening among older women,” wrote lead study author Sida Huang, B.S., who is affiliated with the Yale School of Public Health in New Haven, Ct., and colleagues.
The researchers maintained that access to primary care services played a significant role with mammography screening in this patient population.
Senior women who had dual eligibility for Medicare and Medicaid for at least one month in the year prior to breast cancer diagnosis were 52 percent less likely to have had prior mammography screening within five years preceding diagnosis, according to the study authors.
Three Key Takeaways
1. Routine mammography screening lowers risk. Senior women who had at least one mammography screening within five years prior to diagnosis had a 54 percent lower risk of later-stage breast cancer and a 36 percent lower risk of breast cancer-specific mortality.
2. Frequency of screenings matters. Seniors with three or four mammography screenings in the five years before diagnosis experienced a 37 percent further reduction in breast cancer-specific mortality compared to those with only one screening.
3. Access to primary care and socioeconomic factors influence screening rates. Women with regular primary care visits or annual wellness visits were significantly more likely to undergo mammography screening. In contrast, those with Medicare/Medicaid dual eligibility for at least a month in the year prior to diagnosis or lower socioeconomic status were less likely to receive timely screenings, highlighting disparities in access to preventive care.
The researchers pointed out that women with at least one primary care provider (PCP) visit or annual wellness visit (AWV) in the five-year period prior to breast cancer diagnosis were over 32 percent more likely than those with no PCP or AWV access (78.7 percent vs. 46.4 percent) to have had prior mammography screening.
“We also observed that screening history was correlated with social determinants of health and health care access, including Medicare/Medicaid dual eligibility, area-level education, and primary care use. Patients with lower (socioeconomic status) and less engagement with health care services were less likely to have received prior screenings,” noted Huang and colleagues.
(Editor’s note: For related content, see “AI-Initiated Recalls After Screening Mammography Demonstrate Higher PPV for Breast Cancer,” “Multicenter Mammography Study Shows Greater than 10 Percent Increase in Breast Cancer Detection with Adjunctive AI” and “ECR Mammography Study: Pre-Op CEM Detects 34 Percent More Multifocal Masses than Mammography.”)
In regard to study limitations, the authors acknowledged that in determining whether mammograms in the cohort were screening or diagnostic in nature, there may have been some misclassification due to the claims-based algorithm utilized for the study. Noting the lack of data on breast density and family history in the database used for this study, the researchers conceded they could not assess the impact of these factors on the extent of breast cancer at initial diagnosis.
