Abstract
PurposeTo evaluate mammography uptake and subsequent breast cancer diagnoses, as well as the prospect of additive cancer detection via a liquid biopsy multi-cancer early detection (MCED) screening test during a routine preventive care exam (PCE).MethodsPatients with incident breast cancer were identified from five years of longitudinal Blue Health Intelligence® (BHI®) claims data (2014-19) and their screening mammogram and PCE utilization were characterized. Ordinal logistic regression analyses were performed to identify the association of a biennial screening mammogram with stage at diagnosis. Additional screening opportunities for breast cancer during a PCE within two years before diagnosis were identified, and the method extrapolated to all cancers, including those without recommended screening modalities.ResultsClaims for biennial screening mammograms and the time from screening to diagnosis were found to be predictors of breast cancer stage at diagnosis. When compared to women who received a screening mammogram proximal to their breast cancer diagnosis (0-4 months), women who were adherent to guidelines but had a longer time window from their screening mammogram to diagnosis (4-24 months) had a 87% increased odds of a later-stage (stages III or IV) breast cancer diagnosis (p-value <0.001), while women with no biennial screening mammogram had a 155% increased odds of a later-stage breast cancer diagnosis (p-value <0.001). This highlights the importance of screening in the earlier detection of breast cancer. Of incident breast cancer cases, 23% had no evidence of a screening mammogram in the two years before diagnosis. However, 49% of these women had a PCE within that time. Thus, an additional 11% of breast cancer cases could have been screened if a MCED test had been available during a PCE. Additionally, MCED tests have the potential to target up to 58% of the top 5 cancers that are the leading causes of cancer death currently without a USPSTF recommended screening modality (prostate, pancreatic, liver, lymphoma, and ovarian cancer).ConclusionThe study used claims data to demonstrate the association of cancer screening with cancer stage at diagnosis and demonstrates the unmet potential for a MCED screening test which could be ordered during a PCE.
Highlights
In 2021, there are expected to be approximately 1.9 million new cancer cases and over 600,000 cancer deaths reported in the United States, making it the second leading cause of death in the country [1]
We identified 8,400 incident cancers from the Blue Health Intelligence (BHI) claims data, which included 1,765 breast cancer cases. 2016 SEER data was used as a nationally representative comparator
Using a private payer claims database, we demonstrated that women who underwent a screening mammogram and were subsequently diagnosed with breast cancer in the ensuing four months had earlier stage diagnoses than did women who either did not have any mammograms in the 24 months prior to their diagnosis or who received mammograms in months 4-24 prior
Summary
In 2021, there are expected to be approximately 1.9 million new cancer cases and over 600,000 cancer deaths reported in the United States, making it the second leading cause of death in the country [1]. The 5-year survival rate for breast cancer is 99% for early stage, localized diagnoses but 28% for later-stage, distant diagnoses [2]. The 5-year survival rate for colorectal cancer is 90% for localized and 14% for distant [2]. Survival varies by cancer type, but treatment of earlier stage cancer is consistently associated with improved survival relative to treatment of later stage cancers. This suggests that earlier detection of cancer is critical to improving patient health outcomes
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