Abstract
Introduction: Primary care physicians (PCP) are integral in the early detection of cancer. Patients who are referred to a PCP, or who are assigned a PCP, are more likely to undergo most forms of cancer screening including mammograms and clinical breast examinations. PCPs may also ensure more timely diagnosis after screening abnormalities and prevent diagnostic delay. The Medicare-SEER database was used to explore the possibility of an association between primary care visits and breast cancer outcomes. With the usage of Medicare-SEER data, age, gender, and racial disparities exist.
Methods: A retrospective cohort study design was used to evaluate 109,188 women that were Medicare beneficiaries and diagnosed with breast cancer in SEER registries during the years of 1994–2005. This data was used to analyze the association between primary care encounters and breast cancer outcomes. Health services related to cancer prevention and screening have been shown to occur in the ambulatory setting. The total number of ambulatory physician encounters and the percentage of such encounters with a primary care physician (PCP) were examined over a 24 month period before cancer diagnosis. Women with invasive cancers odds of late American Joint Commission on Cancer (AJCC) stage at diagnosis (stages III and IV vs. stages I and II) and survival (breast cancer specific and all cause) were examined using logistic regression and proportional hazards models respectively. Whether including non-invasive cancers (such as ductal carcinoma in situ, DCIS) would alter results and whether prior mammography was a potential mediator of associations was also explored.
Results: Increasing numbers of ambulatory physician encounters were associated with improved breast cancer outcomes. In addition, subjects having between 40 and 60 percent of all encounters with PCPs were most likely to have had prior mammograms, least likely diagnosed at late stage, and to have lower breast cancer and all-cause mortality. Prior mammography mediated these associations in part but not completely. Results were unchanged when women with DCIS were included in the analysis. The average age of women involved in this study was 77 years old and 86 percent of the sample were non-minority.
Conclusions: Although there is the existence of age, racial, and gender disparities because of the use of the Medicare-SEER data, using this information helps to identify better care tactics for aging women. Medicare beneficiaries with breast cancer had better outcomes if they had greater use of ambulatory care and care that was balanced between primary and specialty providers. These findings suggest adequate primary medical care may be an important factor in achieving optimal breast cancer outcomes.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B68.
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