ASPO Abstracts

Mammography adherence in relation to function-related indicators in older women

Authors: Zhang D, Abraham L, Sprague BL, Onega T, Advani S, Demb J, Miglioretti DL, Henderson LM, Wernli KJ, Walter LC, Kerlikowske K, Schousboe JT, Braithwaite D, Chrischilles E, O'Meara ES

Category: Early Detection & Risk Prediction
Conference Year: 2021

Abstract Body:
Background: Prior epidemiologic studies of screening mammography patterns by functional status in older women show inconsistent results. Methods: We used Breast Cancer Surveillance Consortium (BCSC)-Medicare linked data (1999– 2014) to investigate the association of functional limitation with adherence to screening mammography in 145,478 women aged 66-74 years. Functional limitation was represented by a claims-based function-related indicator (FRI) score which incorporated 16 items reflecting functional status. Baseline adherence was defined as mammography utilization 9-30 months after the last mammogram. Longitudinal adherence was examined among women who were adherent at baseline and defined as time from the index screen to the end of the first 30-month gap in mammography. Multivariable logistic regression and Cox proportional hazards models were used to investigate associations between FRI and baseline and longitudinal adherence, respectively; specifically, non- adherence was treated as the dependent variable in these models. We conducted subgroup analyses to examine if associations differed by age (66-70 vs. 71-74 years). Results: Overall, 69.6% of participants had no substantial functional limitation (FRI score 0), 23.5% had some substantial limitation (FRI score 1), and 6.8% had serious limitations (FRI score≥2). Mean age at baseline was 68.5 years (SD=2.6), 85.3% were white, and 77.1% were adherent to screening guidelines at baseline. Women with a higher burden of functional limitations were more likely to be non-adherent at baseline (FRI≥2 vs. 0: aOR=1.13, 95% CI=1.06, 1.20, p-trend<0.01). In analysis for longitudinal adherence, the median follow-up was 28.6 months (IQR: 5.7-62.2); similarly, a higher FRI score was associated with longitudinal non-adherence (FRI≥2 vs. 0: aHR=1.16, 95% CI=1.11, 1.22, p- trend<0.01). Point estimates of FRI effect measures did not differ substantially by age category. Conclusion: Women aged 66-74 years with a higher burden of functional limitations are less likely to be adherent to screening mammography recommendations.

Keywords: mammography, breast cancer prevention, functional limitation