Ethnic disparities in adherence to breast cancer survivorship surveillance care.

BACKGROUND

Adherence to guidelines for surveillance mammography and clinic visits is an important component of breast cancer survivorship care. Identifying ethnic disparities in adherence may lead to improved care delivery and outcomes.

METHODS

Records were evaluated for 4535 patients who were treated for stage I, II, or III breast cancer at the University of Texas MD Anderson Cancer Center, Houston, Texas, cancer center between January 1997 and December 2006. Generalized estimating equations and Cox proportional hazards analyses were used to evaluate ethnic differences in missed mammograms and clinic visits up to 4 years of follow-up and the impact of those differences on overall survival.

RESULTS

Nonadherence to guidelines for mammography (P = .0002) and clinic visits (P < .0001) increased over time. Hispanic and black patients were more likely to be nonadherent to guidelines for mammography (odds ratio [OR] = 1.35, 95% confidence interval [CI] = 1.10-1.65; OR = 1.36, 95% CI = 1.11-1.66, respectively) and clinic visits (OR = 1.62, 95% CI = 1.27-2.06; OR = 1.45, 95% CI = 1.13-1.86, respectively) than white patients. There was an interaction between Hispanic ethnicity and endocrine therapy on nonadherence to mammography guidelines (P = .001). Nonadherence to mammography and clinic visit guidelines was not associated with overall survival.

CONCLUSIONS

Withdrawal from breast cancer survivorship care increases over time, and black and Hispanic patients are more likely to be nonadherent. An understanding of the reasons for ethnic disparities in adherence to guidelines for mammography and clinic visits is needed to improve retention in survivorship care.