Is reimbursement part of the issue?
Why are breast cancer survivors foregoing recommended screening?
June 06, 2018
by Lauren Dubinsky
, Senior Reporter
The National Comprehensive Cancer Network recommends annual mammograms for breast cancer survivors, but the vast majority of them are not complying with those guidelines — even if they are insured.
Those were the findings of a study recently published in the Journal of the National Comprehensive Cancer Network.
“More research is needed to investigate reasons that some women don’t undergo annual mammography after breast cancer, but I think that a variety of factors may contribute, including busy lives and competing commitments such as caring for children and/or aging parents, employment, etc.; systems issues like barriers to scheduling at a convenient time and distress associated with screening for recurrence,” Dr. Kathryn Ruddy of Mayo Clinic Cancer Center, told HCB News.
Ruddy and her team followed 27,212 patients for about 2.9 years after they underwent breast cancer surgery — with 4,790 patients remaining in the study cohort for at least 65 months. The data came from the OptumLabs Data Warehouse, which contains claims from privately insured patients and Medicare Advantage enrollees in the U.S.
They found that a year after surgery, 13 percent of the survivors did not receive any type of breast imaging. By the five-year mark, 19 percent of them forewent a mammogram in the past year.
Only 50 percent of the patients who were followed for at least five years received at least one mammogram each of those years.
The study also revealed that African-American breast cancer survivors were even less likely to receive mammograms than white Americans. The researchers predict that limited access to genetic testing is contributing to this disparity.
They noted that more research is needed to determine whether variability in reimbursements for imaging exams impacts the use of surveillance testing.
Ruddy encourages clinicians to ensure that their patients are fully aware of the role annual mammograms play in screening for new breast cancers as well as recurrences. She believes that survivorship care plans should be created and implemented with clear follow-up instructions.
“Survivorship care plans are documents given to patients at the completion of their active cancer therapy that explain recommendations for future care including visit schedule and imaging tests,” she said. “These provide an opportunity to emphasize the importance of annual mammography for breast cancer survivors with residual breast tissue.”
There are also mobile applications and web-based programs under development that aim to help patients adhere to post-treatment screening guidelines.