Risk of Advanced-Stage Breast Cancer among Older Women with Comorbidities
Year: 2012
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Comorbidities have been suggested influencing mammography use and breast cancer stage at diagnosis. We compared mammography use, and overall and advanced-stage breast cancer rates, among female Medicare beneficiaries with different levels of comorbidity. METHODS: We used linked Breast Cancer Surveillance Consortium (BCSC) and Medicare claims data from 1998 through 2006 to ascertain comorbidities among 149,045 female Medicare beneficiaries ages 67 and older who had mammography. We defined comorbidities as either "unstable" (life-threatening or difficult to control) or "stable" (age-related with potential to affect daily activity) on the basis of claims within 2 years before each mammogram. RESULTS: Having undergone two mammograms within 30 months was more common in women with stable comorbidities (86%) than in those with unstable (80.3%) or no (80.9%) comorbidities. Overall rates of advanced-stage breast cancer were lower among women with no comorbidities [0.5 per 1,000 mammograms, 95% confidence interval (CI), 0.3-0.8] than among those with stable comorbidities (0.8; 95% CI, 0.7-0.9; P = 0.065 compared with no comorbidities) or unstable comorbidities (1.1; 95% CI, 0.9-1.3; P = 0.002 compared with no comorbidities). Among women having undergone two mammograms within 4 to 18 months, those with unstable and stable comorbidities had significantly higher advanced cancer rates than those with no comorbidities (P = 0.004 and P = 0.03, respectively). CONCLUSIONS: Comorbidities were associated with more frequent use of mammography but also higher risk of advanced-stage disease at diagnosis among the subset of women who had the most frequent use of mammography. IMPACT: Future studies need to examine whether specific comorbidities affect clinical progression of breast cancer.
Institutions: University of Vermont, University of North Carolina at Chapel Hill, Group Health Cooperative, Kaiser Permanente Washington Health Research Institute, University of California, San Francisco, University of California Davis Medical Center, Dartmouth Cancer Center, University of California, Davis
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1353929375, San Francisco Mammography Registry-A Research Source, Carolina Mammography Registry, G339124968, G407747206, Breast Cancer Surveillance in a Defined Population, G4299498666, G4443073989, G4593227348, G5117928749, NEW MEXICO MAMMOGRAPHY PROJECT, Vermont Breast Cancer Surveillance System, G613175501, G640097384, Statistical Coordinating Center for the Breast Cancer Surveillance Consortium, G6576638341, New Hampshire Mammography Registry: Strategic Studies in Screening, BREAST CANCER SURVEILLANCE RESEARCH IN COLORADO, G79717682, Screening Mammography in elderly Women using linked BCSC - Medicare data
OpenAlex ID: W2113014385