Abstract PD08-01: The Association of Health Insurance and Other Factors with Mammography Surveillance among Breast Cancer Survivors
Authors: Sabatino SA , Thompson T , Richardson LC , Miller J. 
Published: April 2011

Abstract
Introduction: Annual mammograms are recommended for surveillance of breast cancer survivors. Whether disparities in mammography surveillance exist by health insurance status is unknown. We examined the association of mammography use with insurance and other factors among breast cancer survivors in a nationally representative sample.
Methods: We combined data from the 2000, 2003, 2005 and 2008 National Health Interview Survey (the most recent years that included mammography questions). We included 1,582 women age≥30 with breast cancer history. Our dependent variable was a mammogram within the prior year. We categorized insurance as any private (health maintenance organization/independent practice association (HMO/IPA), other private, unspecified private), public only (Medicare and Medicaid, other Medicare coverage, other public), and uninsured. Statistical tests were performed using Pearson chi-square tests. Multivariable logistic regression was used to determine factors independently associated with mammography. Age, race/ethnicity, education, time since diagnosis, health status, insurance, ratio of income to federal poverty threshold, having a usual provider, and survey year were included in models. For insurance, pairwise comparisons were used to compare private vs. other insurance groups. Model results are presented as predictive margins. All data were weighted to account for the complex survey design and non-response.
Results: Overall 75% reported a mammogram. Publicly insured and uninsured women were less likely than privately insured women to report a mammogram. Nearly one-third of publicly insured, one half of uninsured, and one quarter of privately insured women did not report a mammogram. (69% and 54% vs. 79% respectively, p.0006). Lower use for publicly insured women was largely due to women dually-eligible for Medicare and Medicaid (61%, 95%CI 45-75%) and women with other Medicare coverage (69%, CI 62-75%). After adjustment, use continued to be lower for publicly insured (71% vs. 77%, p=.048) and uninsured women (65% vs. 77%, p=.145) vs. privately insured women. Fewer women age&lt;50 or age≥75 reported mammograms than women ages 50-64 and 65-74 (67%, 72%, 77% and 80% respectively, p=.021). Greater time since diagnosis (75% for 5-9 yrs and 67% for ≥10 yrs vs. 85% for 1-&lt;3 yrs, 88% for 3-&lt;5 yrs and 93% for &lt;1 yr, p&lt;.0001) and having no usual provider (39% vs. 76%, p&lt;.0001) were also significantly associated with not reporting a mammogram. Lower mammography use among women in the other Medicare vs. privately insured groups was of borderline significance (70% vs. 77%, p=.053).
Conclusion: One in four breast cancer survivors in this nationally representative sample did not report guideline concordant mammography surveillance. Publicly insured women were less likely than privately insured women to report a mammogram. Few were uninsured. Larger samples are needed to examine mammography use for this group. Efforts to understand barriers and promote mammography among publicly insured survivors, young survivors, older survivors for whom ongoing surveillance is appropriate, those ≥5 years post-diagnosis and with no usual provider are needed.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD08-01.