Influence of Primary Care on Breast Cancer Outcomes Among Medicare Beneficiaries
Open Access
- 1 September 2012
- journal article
- Published by Annals of Family Medicine in Annals of Family Medicine
- Vol. 10 (5), 401-411
- https://doi.org/10.1370/afm.1398
Abstract
PURPOSE We used the Surveillance Epidemiology and End Results (SEER)-Medicare database to explore the association between primary care and breast cancer outcomes. METHODS Using a retrospective cohort study of 105,105 female Medicare beneficiaries with a diagnosis of breast cancer in SEER registries during the years 1994–2005, we examined the total number of office visits to primary care physicians and non–primary care physicians in a 24-month period before cancer diagnosis. For women with invasive cancers, we examined the odds of diagnosis of late-stage disease, according to the American Joint Commission on Cancer (AJCC) (stages III and IV vs stages I and II), and survival (breast cancer specific and all cause) using logistic regression and proportional hazards models, respectively. We also explored whether including noninvasive cancers, such as ductal carcinoma in situ (DCIS), would alter results and whether prior mammography was a potential mediator of associations. RESULTS Primary care physician visits were associated with improved breast cancer outcomes, including greater use of mammography, reduced odds of late-stage diagnosis, and lower breast cancer and overall mortality. Prior mammography (and resultant earlier stage diagnosis) mediated these associations in part, but not completely. Similar results were seen for non–primary care physician visits. Results were similar when women with DCIS were included in the analysis. CONCLUSIONS Medicare beneficiaries with breast cancer had better outcomes if they made greater use of a primary care physician’s ambulatory services. These findings suggest adequate primary medical care may be an important factor in achieving optimal breast cancer outcomes.Keywords
This publication has 78 references indexed in Scilit:
- Primary Care Specialty Choices of United States Medical Graduates, 1997–2006Academic Medicine, 2010
- Primary Care: Current Problems And Proposed SolutionsHealth Affairs, 2010
- Primary Care: A Critical Review Of The Evidence On Quality And Costs Of Health CareHealth Affairs, 2010
- Principles of the Patient-Centered Medical Home and Preventive Services DeliveryAnnals of Family Medicine, 2010
- Physician Supply and Breast Cancer SurvivalThe Journal of the American Board of Family Medicine, 2010
- The Role of Primary Care Physicians in Cancer CareJournal of General Internal Medicine, 2009
- Associations of physician supplies with breast cancer stage at diagnosis and survival in Ontario, 1988 to 2006Cancer, 2009
- Under Utilization of Surveillance Mammography among Older Breast Cancer SurvivorsJournal of General Internal Medicine, 2007
- The Effect of Patient Navigation on Time to Diagnosis, Anxiety, and Satisfaction in Urban Minority Women with Abnormal Mammograms: A Randomized Controlled TrialJournal of Urban Health, 2007
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987