Screening Mammography Utilization Among Elderly Women with Comorbidities and Breast Cancer Using Linked Breast Cancer Surveillance Consortium - Medicare Data

Grant number: 1R03CA139567-01
PI Name: Yasmeen S
Title: Screening Mammography Utilization Among Elderly Women with Comorbidities and Breast Cancer Using Linked Breast Cancer Surveillance Consortium - Medicare Data

Breast cancer incidence increases with age, and more than half of breast cancers occur in women aged 61 years and older. The incidence of breast cancer is highest (464.8 per 100,000 women) in women 75 to 79 years of age. Despite efforts to promote screening and early diagnosis, approximately 48% of elderly women have metastatic disease and 9% have an unknown stage at presentation. SEER-Medicare data suggest that less frequent use of screening mammography may explain the higher risk of stage IIA or worse disease, and the increased mean tumor size, among women 75 or more years of age. The effectiveness of screening mammography in decreasing mortality in women 75 to 79 years of age was demonstrated by two recent randomized controlled trials from Netherlands. Regular mammography use in this age group was associated with 29.5% lower mortality rate, and a higher positive predictive value for breast cancer diagnosis 47% versus 36% in women age 50-69 years. This RO3 research proposal is submitted as an extension to an NCI-funded KO7 award "to evaluate the impact of comorbidities on screening mammography utilization, stage at diagnosis, treatment, survival, and physician's decisions to recommend, and patients' decisions to accept, screening mammography among elderly women with comorbidities utilizing linked SEER-Medicare data from 1993 through 2005". The purpose of this research proposal is to determine screening mammography utilization rates, and survival among elderly women with comorbidities, and to examine the impact of race/ethnicity, and socioeconomic status on screening mammography use and stage at diagnosis of breast cancer among elderly Medicare beneficiaries without a previous history of breast cancer utilizing SEER-Medicare and Breast Cancer Surveillance Consortium (BCSC) database. The primary source of data for this study will be the merged file containing information (demographic variables, health history, current health, breast symptoms, radiology history, and follow-up) from the Breast Cancer Surveillance Consortium dataset linked to the linked SEER-Medicare file available at California Cancer Registry (CCR). The Breast Cancer Surveillance Consortium database collects information from eight participating mammography registries in the US.

This proposal is a collaborative project with BCSC investigators from UCSF. The linked data is anticipated to be available in October 2008, and the data will be analyzed at the BCSC coordinating center.