SAN FRANCISCO—Elderly women who survived breast cancer received more preventive health care overall than a matched control group of cancer-free women. This finding was based on a review of financial records by researchers at the Center for Outcomes and Policy Research at Dana-Farber Cancer Institute in Boston.
Despite greater access to the health care system, however, breast cancer survivors who were poor, black, or from certain geographic areas received fewer preventive services than their peers. "Breast cancer survivors as a group seem to receive fairly good noncancer care. However, inequities still exist based on race and geography," reported Craig C. Earle, MD, MSc, an assistant professor of medicine at Harvard Medical School.
The investigators undertook the study of a nationwide, population-based sample to determine whether the reliance of breast cancer survivors on specialists and the emphasis on cancer as a threat to their lives was leading to more or less attention for competing health concerns. They linked records from the Health Care Financing Administration (HCFA) data to the SEER (Survival, Epidemiology, and End-Results) registry to identify 5,965 survivors and 6,062 women in a control group matched for age, race, and geographical area.
Health Care Contacts
Among the breast cancer survivors, 71% were node negative, 45% had comorbidities, and the mean age was 78.7 years. Both groups were 89% white. The mean age of the control group was 78 years, and 42% had comorbidities. Heart disease and diabetes were said to be slightly more common in the survivors. The rate of myocardial infarction was slightly lower, however: 2.1% for the survivors vs 2.5% for the control group.
Examining Medicare records for 1997 and 1998, the investigators determined that all of the survivors had at least one contact with a health care provider during those two years. Billing records indicated that 7% of the control group had no contacts.
Higher percentages of breast cancer survivors had:
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flu shots, 65% vs 58% for controls;
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lipid testing, 48% vs 43% for controls;
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cervical examinations, 31% vs 27% for controls;
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colon examinations, 17% vs 14% for controls; and
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bone densitometry, 8.3% vs 6.8% for controls.
The patients treated in teaching hospitals were more likely to have lipid testing and screening for colorectal cancer. Dr. Earle said that the geographic variability was between SEER registry areas, but declined to name the areas at this time.
More Mammograms
"As we would hope, mammography was done much more often in survivors than in controls," Dr. Earle said. "Seventy-four percent may seem like a low number, but if restricted to patients under age 75, the percentage rises into the mid-eighties." The mammography rate for the control group was 41%. If only women who had prior mammography were included in the control group, however, the disparity in medical services disappeared between the breast cancer survivors and the control group.
Lower Overall Cost
Although the cost differential was statistically insignificant, Dr. Earle noted that the breast cancer survivors had fewer hospitals days and incurred lower overall cost than the control group: $8,748 vs $9,018. "Even though breast cancer survivors seem to receive more services in the form of preventive care, the trends are that they appear to use less resources overall," he said.
"The implications are that we’re doing well overall in routine preventive care for breast cancer survivors as a group, and it seems that being engaged in the health care system for one reason may have beneficial effects in other areas, but there are still significant problems," Dr. Earle concluded. "Even for these women compelled to participate in the health care system, significant disparities still exist based on nonmedical factors. We need to continue to find ways to reach out to vulnerable groups with low levels of health care participation."
