Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium

Elisabeth F. Beaber, Anna N A Tosteson, Jennifer S. Haas, Tracy Onega, Brian L. Sprague, Donald L. Weaver, Anne Marie McCarthy, Chyke A. Doubeni, Virginia P. Quinn, Celette Sugg Skinner, Ann G. Zauber, William E. Barlow

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Although United States clinical guidelines differ, the earliest recommended age for average risk breast cancer screening is 40 years. Little is known about factors influencing screening initiation. Methods: We conducted a cohort study within the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We identified 3413 women on their 40th birthday in primary care networks at Geisel School of Medicine at Dartmouth (DH) and Brigham and Women’s Hospital (BWH) during 2011–2013 with no prior breast imaging or breast cancer. Cumulative incidence curves and Cox modeling were used to determine time from the 40th birthday to first breast cancer screening, cohort exit, or 42nd birthday. We calculated hazards ratios and 95 % confidence intervals from multivariable Cox proportional hazards models. Results: Breast cancer screening cumulative incidence by the 42nd birthday was 62.9 % (BWH) and 39.8 % (DH). Factors associated with screening initiation were: a primary care visit within a year (HR 4.99, 95 % CI 4.23–5.89), an increasing number of primary care visits within a year (p for trend <0.0001), ZIP code of residence annual median household income ≤$52,000 (HR 0.79, 95 % CI 0.68–0.92), and health insurance type (Medicaid HR 0.72, 95 % CI 0.58–0.88; Medicare HR 0.55, 95 % CI 0.39–0.77; uninsured HR 0.37, 95 % CI 0.25–0.57). Conclusions: Breast cancer screening uptake after the 40th birthday varies by health system, primary care visits, median household income, and health insurance type, suggesting the need for further exploration. Future research should evaluate screening performance metrics after initiation and consider cumulative benefits and risks associated with breast cancer screening over time.

Original languageEnglish (US)
Pages (from-to)323-331
Number of pages9
JournalBreast Cancer Research and Treatment
Volume160
Issue number2
DOIs
StatePublished - Nov 1 2016

Fingerprint

Early Detection of Cancer
Breast Neoplasms
Primary Health Care
Research
Population
National Cancer Institute (U.S.)
Incidence
Medicaid
Health Insurance
Medicare
Proportional Hazards Models
Breast
Cohort Studies
Medicine
Guidelines
Confidence Intervals
Health

Keywords

  • Breast neoplasms
  • Early detection of cancer
  • Mammography
  • Mass screening
  • Prevention & control
  • Primary health care

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Beaber, E. F., Tosteson, A. N. A., Haas, J. S., Onega, T., Sprague, B. L., Weaver, D. L., ... Barlow, W. E. (2016). Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium. Breast Cancer Research and Treatment, 160(2), 323-331. https://doi.org/10.1007/s10549-016-3990-x

Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium. / Beaber, Elisabeth F.; Tosteson, Anna N A; Haas, Jennifer S.; Onega, Tracy; Sprague, Brian L.; Weaver, Donald L.; McCarthy, Anne Marie; Doubeni, Chyke A.; Quinn, Virginia P.; Skinner, Celette Sugg; Zauber, Ann G.; Barlow, William E.

In: Breast Cancer Research and Treatment, Vol. 160, No. 2, 01.11.2016, p. 323-331.

Research output: Contribution to journalArticle

Beaber, EF, Tosteson, ANA, Haas, JS, Onega, T, Sprague, BL, Weaver, DL, McCarthy, AM, Doubeni, CA, Quinn, VP, Skinner, CS, Zauber, AG & Barlow, WE 2016, 'Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium', Breast Cancer Research and Treatment, vol. 160, no. 2, pp. 323-331. https://doi.org/10.1007/s10549-016-3990-x
Beaber, Elisabeth F. ; Tosteson, Anna N A ; Haas, Jennifer S. ; Onega, Tracy ; Sprague, Brian L. ; Weaver, Donald L. ; McCarthy, Anne Marie ; Doubeni, Chyke A. ; Quinn, Virginia P. ; Skinner, Celette Sugg ; Zauber, Ann G. ; Barlow, William E. / Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium. In: Breast Cancer Research and Treatment. 2016 ; Vol. 160, No. 2. pp. 323-331.
@article{449ad136bafd48f1a104a6726c4c1fa9,
title = "Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium",
abstract = "Purpose: Although United States clinical guidelines differ, the earliest recommended age for average risk breast cancer screening is 40 years. Little is known about factors influencing screening initiation. Methods: We conducted a cohort study within the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We identified 3413 women on their 40th birthday in primary care networks at Geisel School of Medicine at Dartmouth (DH) and Brigham and Women’s Hospital (BWH) during 2011–2013 with no prior breast imaging or breast cancer. Cumulative incidence curves and Cox modeling were used to determine time from the 40th birthday to first breast cancer screening, cohort exit, or 42nd birthday. We calculated hazards ratios and 95 {\%} confidence intervals from multivariable Cox proportional hazards models. Results: Breast cancer screening cumulative incidence by the 42nd birthday was 62.9 {\%} (BWH) and 39.8 {\%} (DH). Factors associated with screening initiation were: a primary care visit within a year (HR 4.99, 95 {\%} CI 4.23–5.89), an increasing number of primary care visits within a year (p for trend <0.0001), ZIP code of residence annual median household income ≤$52,000 (HR 0.79, 95 {\%} CI 0.68–0.92), and health insurance type (Medicaid HR 0.72, 95 {\%} CI 0.58–0.88; Medicare HR 0.55, 95 {\%} CI 0.39–0.77; uninsured HR 0.37, 95 {\%} CI 0.25–0.57). Conclusions: Breast cancer screening uptake after the 40th birthday varies by health system, primary care visits, median household income, and health insurance type, suggesting the need for further exploration. Future research should evaluate screening performance metrics after initiation and consider cumulative benefits and risks associated with breast cancer screening over time.",
keywords = "Breast neoplasms, Early detection of cancer, Mammography, Mass screening, Prevention & control, Primary health care",
author = "Beaber, {Elisabeth F.} and Tosteson, {Anna N A} and Haas, {Jennifer S.} and Tracy Onega and Sprague, {Brian L.} and Weaver, {Donald L.} and McCarthy, {Anne Marie} and Doubeni, {Chyke A.} and Quinn, {Virginia P.} and Skinner, {Celette Sugg} and Zauber, {Ann G.} and Barlow, {William E.}",
year = "2016",
month = "11",
day = "1",
doi = "10.1007/s10549-016-3990-x",
language = "English (US)",
volume = "160",
pages = "323--331",
journal = "Breast Cancer Research and Treatment",
issn = "0167-6806",
publisher = "Springer New York",
number = "2",

}

TY - JOUR

T1 - Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium

AU - Beaber, Elisabeth F.

AU - Tosteson, Anna N A

AU - Haas, Jennifer S.

AU - Onega, Tracy

AU - Sprague, Brian L.

AU - Weaver, Donald L.

AU - McCarthy, Anne Marie

AU - Doubeni, Chyke A.

AU - Quinn, Virginia P.

AU - Skinner, Celette Sugg

AU - Zauber, Ann G.

AU - Barlow, William E.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Purpose: Although United States clinical guidelines differ, the earliest recommended age for average risk breast cancer screening is 40 years. Little is known about factors influencing screening initiation. Methods: We conducted a cohort study within the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We identified 3413 women on their 40th birthday in primary care networks at Geisel School of Medicine at Dartmouth (DH) and Brigham and Women’s Hospital (BWH) during 2011–2013 with no prior breast imaging or breast cancer. Cumulative incidence curves and Cox modeling were used to determine time from the 40th birthday to first breast cancer screening, cohort exit, or 42nd birthday. We calculated hazards ratios and 95 % confidence intervals from multivariable Cox proportional hazards models. Results: Breast cancer screening cumulative incidence by the 42nd birthday was 62.9 % (BWH) and 39.8 % (DH). Factors associated with screening initiation were: a primary care visit within a year (HR 4.99, 95 % CI 4.23–5.89), an increasing number of primary care visits within a year (p for trend <0.0001), ZIP code of residence annual median household income ≤$52,000 (HR 0.79, 95 % CI 0.68–0.92), and health insurance type (Medicaid HR 0.72, 95 % CI 0.58–0.88; Medicare HR 0.55, 95 % CI 0.39–0.77; uninsured HR 0.37, 95 % CI 0.25–0.57). Conclusions: Breast cancer screening uptake after the 40th birthday varies by health system, primary care visits, median household income, and health insurance type, suggesting the need for further exploration. Future research should evaluate screening performance metrics after initiation and consider cumulative benefits and risks associated with breast cancer screening over time.

AB - Purpose: Although United States clinical guidelines differ, the earliest recommended age for average risk breast cancer screening is 40 years. Little is known about factors influencing screening initiation. Methods: We conducted a cohort study within the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We identified 3413 women on their 40th birthday in primary care networks at Geisel School of Medicine at Dartmouth (DH) and Brigham and Women’s Hospital (BWH) during 2011–2013 with no prior breast imaging or breast cancer. Cumulative incidence curves and Cox modeling were used to determine time from the 40th birthday to first breast cancer screening, cohort exit, or 42nd birthday. We calculated hazards ratios and 95 % confidence intervals from multivariable Cox proportional hazards models. Results: Breast cancer screening cumulative incidence by the 42nd birthday was 62.9 % (BWH) and 39.8 % (DH). Factors associated with screening initiation were: a primary care visit within a year (HR 4.99, 95 % CI 4.23–5.89), an increasing number of primary care visits within a year (p for trend <0.0001), ZIP code of residence annual median household income ≤$52,000 (HR 0.79, 95 % CI 0.68–0.92), and health insurance type (Medicaid HR 0.72, 95 % CI 0.58–0.88; Medicare HR 0.55, 95 % CI 0.39–0.77; uninsured HR 0.37, 95 % CI 0.25–0.57). Conclusions: Breast cancer screening uptake after the 40th birthday varies by health system, primary care visits, median household income, and health insurance type, suggesting the need for further exploration. Future research should evaluate screening performance metrics after initiation and consider cumulative benefits and risks associated with breast cancer screening over time.

KW - Breast neoplasms

KW - Early detection of cancer

KW - Mammography

KW - Mass screening

KW - Prevention & control

KW - Primary health care

UR - http://www.scopus.com/inward/record.url?scp=84991389297&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84991389297&partnerID=8YFLogxK

U2 - 10.1007/s10549-016-3990-x

DO - 10.1007/s10549-016-3990-x

M3 - Article

C2 - 27665586

AN - SCOPUS:84991389297

VL - 160

SP - 323

EP - 331

JO - Breast Cancer Research and Treatment

JF - Breast Cancer Research and Treatment

SN - 0167-6806

IS - 2

ER -