Background: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is a nationwide, comprehensive public health program that provides uninsured, underinsured, and underserved women with access to screening and diagnostic services for breast and cervical cancer. The program enrolls asymptomatic women for cancer screening and symptomatic women for diagnostic services. While the NBCCEDP prioritizes screening for breast cancer to women aged 50 to 64 years, requiring that at least 75% of all program-paid mammograms be provided to this priority population, some women aged 40-49 years also receive services. This study describes the results of mammograms provided by the NBCCEDP, by exam indication (screening or diagnostic) and age group.
Methods: For women receiving an NBCCEDP-funded mammogram from 2009 through 2012, we calculated age- specific percentages of abnormal findings, and rates of follow-up testing, biopsy, and invasive and in situ breast cancer diagnosis per 1,000 mammograms. Logistic regression was used to estimate the odds for each of these outcomes by exam indication. The odds ratios (ORs) were adjusted for age, race/ethnicity, rural or urban residence, and region.
Results: From 2009 2012, 941,649 screening and 175,310 diagnostic mammograms were provided to women in the NBCCEDP. A small proportion (2.7%; 30,434) of mammograms had unknown indications. Most women were white, non-Hispanic (46.7%), Hispanic (24.4%) or Black, non-Hispanic (18.1%). The percentage of abnormal mammograms was higher for diagnostic mammograms (40.1 %) than screening mammograms (15.5 %). Compared with women aged 40-49 years, fewer women aged 50-64 years had abnormal results for screening (13.7% vs. 19.7%; OR=0.65; 95% confidence interval [CI]: 0.64-0.66) and diagnostic mammograms (37.7% vs, 42.7%; OR=0.82, 95% CI: 0.80-0.83). Overall, the follow-up rates for screening and diagnostic mammograms were 163.1 and 699.7 per 1,000 mammograms; biopsy rates were 26.8 and 168.7, respectively. Follow-up testing rates were lower among women aged 50-64 years compared to those aged 40-49 years (screening: 143.9 vs. 207.5; diagnostic: 645.3 vs. 760.9); biopsy rates exhibited a similar pattern (screening: 24.1 vs. 32.9; diagnostic: 167.7 vs. 169.7). The cancer detection rates for diagnostic mammograms were higher than screening mammograms for invasive (53.1 vs 3.2 per 1,000) and in situ (14.5 vs. 2.2 per 1,000) cancers. For screening mammograms, older women had more cancers detected than younger women (invasive: 3.6 vs. 2.2; in situ: 2.3 vs. 2.0). Similarly, for diagnostic mammograms, cancer detection was higher for older women (invasive: 67.8 vs. 36.6; in situ: 17.4 vs. 11.1).
Conclusions: Abnormal mammograms and diagnostic follow-up procedures were less frequent in women aged 50–64 years compared to women aged 40–49 years; however, breast cancer detection was higher for women aged 50-64 years, regardless of indication for the mammogram. Some of these differences between age groups were greater for screening mammograms than for diagnostic mammograms. Cancer detection rates were higher for diagnostic mammograms compared with screening mammograms. These findings support the NBCCEDP's priority of serving women aged 50–64 years. Further, it highlights the need to continue to focus on women at higher risk for developing breast cancer. By providing access to both screening and diagnostic mammograms, NBCCEDP offers much-needed services to this high-risk population. More targeted public health efforts are needed to improve access to screening, timely follow-up and treatment for breast cancer for all women in the United States.
Citation Format: Arica White, Jacqueline Miller, Janet Royalty, A. Blythe Ryerson, Vicki Benard. Outcomes of mammography in the National Breast and Cervical Cancer Early Detection Program. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B78.