Mammography use among breast cancer survivors: Administrative data and chart review

Abstract

6569 Background: At least 13 articles, including 5 in the Journal of Clinical Oncology, have reported low rates of mammography in breast cancer survivors. In studies analyzing the first 12 to 18 months following breast cancer diagnosis and/or treatment, mammography rates were typically between 70% and 80%. Analyses of administrative data at our institution, Park Nicollet Health Services (PNHS), showed the same result despite oncologists' insistence that they were diligent about this aspect of follow-up care. Method: Using the PNHS Cancer Registry, we identified 191 women diagnosed with non-metastatic breast cancer at PNHS in 2001 who allowed their records to be used for research, were alive as of January 15, 2007, and received cancer care and primary care within PNHS. We used the PNHS administrative (claims) database to determine whether each woman received mammography during the year following active breast cancer treatment, and we used the PNHS electronic medical record to review charts of women who according to claims data did not. Results: Administrative data indicated that 79.1% of women received mammography during the year following active treatment for breast cancer, an estimate in agreement with published studies. However, chart review of those who did not receive mammography indicated that 26 had undergone bilateral mastectomy; only 16 of these were indicated in the Cancer Registry. An additional 2 women had received mammography but their medical record and billing identifiers mismatched, and 3 women received mammography out of system. The final mammography rate was 94.5%. Conclusion: Published reports underestimate mammography rates in breast cancer survivors, primarily because of failure to exclude women who have had bilateral mastectomy. Only 4 reports mentioned that women with bilateral mastectomy were excluded, and in 2 of those, the proportions excluded were less than 1.5%. Studies should document type of surgery in order to provide a realistic picture of the care of breast cancer survivors. No significant financial relationships to disclose.