The Quality of Non-Cancer Care Delivered to Elderly Breast Cancer Survivors

Heather Jones, MD

University of Pennsylvania Cancer
Last Modified: May 12, 2001

Presenter: C.C. Earle, H. f Burstein, F. P. Winer, J. C. Weeks
Affiliation: Dana-Farber Cancer institute, Boston, MA


    There are currently more than 2 million breast cancer survivors in the US; as screening and treatment improve we expect that this number will increase. Elderly survivors of breast cancer, like their non-breast cancer counterparts, are faced with numerous competing risk factors such as colon cancer, cervical cancer and other chronic illnesses. This study examines the quality, and determinants of quality, of non-cancer care delivered to breast cancer survivors.

Materials and Methods:

  • This study compared the use of routinely recommended preventive services in older breast cancer survivors with that of matched controls by analyzing their billing data over the calendar years 1997-98.
  • Survivors were defined as all women previously diagnosed with non-metastatic breast cancer while residing in one of the regions monitored by the Survival, Epidemiology, and End-Results (SEER) program, who had been alive and apparently free of disease for at least 5 years.
  • They must have been 65 years of age or older at the start of the study, and must have had complete billing records in linked Medicare files throughout the observation period.
  • Non-cancer controls were taken from a 5% Medicare sample and matched to each case on age, race, and geographic location.


  • Breast cancer survivors were significantly more likely than matched controls to receive all preventive services, including influenza vaccination (64% vs. 58%), blood lipid testing (49% vs. 43%), cervical cancer screening (34% vs. 27%), and colorectal cancer screening (17% vs. 14%).
  • Breast cancer survivors were more likely to have mammograms 74% vs. 41%.
  • However, even after adjusting for age and comorbidity, the rates of preventive services in both groups were significantly lower for poor patients, African-Americans, and those living in certain rural areas.
  • Patients were more likely to undergo lipid testing and colorectal cancer screening if they received care in a teaching hospital.
  • All survivors had at least one contact with a health care provider during the two years of the study, but 7% of matched controls had no medical encounters.

Authors' Conclusions

  • Breast cancer survivors have more interaction with the health care system than matched controls, and experience better quality non-cancer preventive care.
  • Despite this, differential access based on non-medical factors is still significant.
  • These results highlight the importance of health care participation in the delivery of high quality services.

Clinical/Scientific Implications:

    It is encouraging to see that breast cancer survivors are getting such good preventative care. It is however, concerning that even when compelled to interact with the medical system, some women do not receive the screening they need. It is important to address this differential access.

OncoLink ASCO 2001 coverage is provided by an unrestricted educational grant from Amgen