Benefit Type and Care Source in Relation to Mammography Screening and Breast Cancer Stage at Diagnosis among DoD Beneficiaries Janna Manjelievskaia1, Derek Brown1,Stephanie Shao1,2, Keith Hofmann3, Craig D. Shriver1,2, Kangmin Zhu1,2 1John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD; 2Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD; 3Kennell and Associates, Inc. Introduction Methods Results Results Tumor Stage at Diagnosis: Those with Prime had a higher percentage of Stage I and lower percentage of stage 4 tumors Women with Prime and those who received indirect care (vs direct) were more likely to have a lower stage at diagnosis No differences in tumor stage were seen for women who received both direct and indirect care vs. direct care Breast cancer is the second leading cause of cancer death among women in the U.S. Mammography screening can reduce mortality from breast cancer. Type of insurance can impact an individual’s likelihood of receiving a screening mammogram. Variation in tumor stage at diagnosis exists for patients with different types of insurance. Less is known about the differences in mammography screening among beneficiaries in the Department of Defense (DoD), an equal access healthcare system. To examine differences in mammography screening before breast cancer diagnosis and tumor stage at diagnosis among: different benefit types care sources within the DoD healthcare system Linked data from the DoD’s Central Cancer Registry (CCR) and MHS Data Repository (MDR) medical claims database were used Study subjects: women ages 40-64 with histologically confirmed, malignant breast cancer diagnosed between 2003-2007 Demographics, tumor characteristics, benefit type, and care source were obtained from CCR/MDR records Multivariable logistic regression models assessed differences by benefit type and care source for receipt of screening mammography and tumor stage at diagnosis Statistical analysis performed in SAS 9.3 Conclusion No differences in mammography screening by benefit type were observed after controlling for demographics and comorbidities Women with Prime were less likely to have a higher tumor stage at diagnosis Underlying reasons for differences are not clear, but may include: Out of pocket costs Distance from medical treatment facilities Frequency of healthcare visits for other medical problems Objective Results Demographics: Study included 2,668 subjects and most had Tricare Prime (90.4%) Among those with Prime, most were non-Hispanic White (58.91%), aged 40-49 (40.67%), non-active duty (93.45%), with no comorbidities (73.71%) Nearly half had direct care (48.67%) Screening Mammography: Of those with Prime, 56.88% had a screening mammography Benefit type was not a significant predictor of receipt of mammography Women with indirect care were more likely to receive one than those with direct care (OR 1.54, 95% CI 1.24-1.91), across all age groups Specific Aims References To assess whether receipt of screening mammography before diagnosis varies by Tricare Prime benefit status (prime vs not prime) and care source (direct, indirect, or both) To examine whether differences in tumor stage (3&4 vs 1&2) at diagnosis exist among different Tricare benefit types and care sources. Centers for Disease Control and Prevention (CDC). (2015). Breast cancer statistics. Retrieved from http://www.cdc.gov/cancer/breast/statistics/ Cady B, Michaelson JS, Chung MA. The “tipping point” for breast cancer mortality decline has resulted from size reductions due to mammographic screening. Ann Surg Oncol. 2011; 18(4):903– 906. Bradley CJ, Given CW, Roberts C. (2002). Race, socioeconomic status, and breast cancer treatment and survival. J Natl Cancer Inst, 94(7): 490-6. Yu X. (2009). Socioeconomic disparities in breast cancer survival: relation to stage at diagnosis, treatment and race. BMC Cancer, 9(1): 364. Carney PA, O'Malley J, Buckley DI, Mori M, Lieberman DA, Fagnan LJ, Wallace J, Liu B, Morris C. Influence of health insurance coverage on breast, cervical, and colorectal cancer screening in rural primary care settings. Cancer 2012, 118(24):6217-6225. Farkas DT, Greenbaum A, Singhal V, Cosgrove JM. Effect of insurance status on the stage of breast and colorectal cancers in a safety-net hospital. Am J Manag Care 2012, 18(5 Spec No. 2):SP65-70 Sabatino SA, Thompson TD, Richardson LC, Miller J. Health insurance and other factors associated with mammography surveillance among breast cancer survivors: results from a national survey. Med Care 2012, 50(3):270-276.