1. 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 with histologically confirmed, malignant breast cancer diagnosed between
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 (40.67%), 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 ), 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
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