Session Title: Health Services Research
Session Type: Abstract Submissions (ACR)
Aromatase inhibitors (AI) are increasingly used as adjuvant hormonal therapy in postmenopausal women with estrogen receptor-positive breast cancer. It is well recognized that therapy with AI increases the risk of bone loss and fractures. Therefore, it has been recommended that women who are beginning AI therapy undergo bone mineral density (BMD) measurement at baseline and periodic intervals. The objective of our study was to determine the rates and predictors of dual-energy x-ray absorptiometry (DXA) scan use in breast cancer patients started on AI in the state of Texas who were Medicare beneficiaries.
In a retrospective cohort study, we identified all Medicare female beneficiaries diagnosed with breast cancer in the period 2005-2010 from the Texas Cancer Registry/Medicare claims-linked database available through the Comparative Effectiveness Research on Cancer in Texas (CERCIT) consortium. Claims for DXA were obtained from Medicare part B for a period from one year before to 6 months after AI initiation. We also evaluated the use of bone-conserving agents (BCA). We collected data for prescription drugs from Medicare part D claims. We used multivariate logistic regression models to determine the association of sociodemographic variables with DXA use after controlling for disease stage and type of AI.
Our breast cancer study cohort included 3587 women. Of these, 1999 (55.7%) underwent DXA between 1 year before and 6 months after AI initiation. Women aged 75 and above were less likely to receive DXA (odds ratio [OR], 0.80 (0.70-0.91) and less likely to receive either DXA or BCA (OR, 0.80; 95% CI, 0.70-0.92) than were women aged 66-74 years. African American women were less likely to receive DXA (OR, 0.70; 95% CI, 0.53-0.92) and less likely to receive either DXA or BCA than were non-Hispanic white women (OR, 0.68; 95% CI, 0.52-0.90).
Women living in urban areas were less likely to undergo DXA than women living in big metropolitan areas (OR, 0.71; 95% CI, 0.53-0.97). Women with state buy-in enrollment plans were less likely to receive DXA (OR, 0.61; 95% CI, 0.51-0.73 ) and less likely to receive either DXA or BCA (OR, 0.62; 95% CI, 0.51-0.74) than were women with no such enrollment .Of 3587 patients, 681 (18.98%= 19%) received BCA and 2162 (60.3%) either received either BCA or DXA when starting AI.
Slightly more than 50% of Texas Medicare female beneficiaries with breast cancer beginning AI treatment received DXA. Rates of DXA varied with the patient’s age, size of area of residence, and socioeconomic status. Differences between ethnic groups in the use of DXA/BCA were noted, with fewer African American women compared to white women receiving DXA or BCA.
M. E. Suarez-Almazor,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/low-rates-of-bone-mineral-density-testing-in-medicare-beneficiaries-with-breast-cancer-starting-aromatase-inhibitor-therapy/