News release: Colorado - Denver/Boulder

October 19, 2004

For more information, call:
Jacque Murphy Montgomery
Kaiser Permanente, Media Relations Coordinator
Phone: (303) 344-7410
E-mail: Jacque.Montgomery@kp.org

Last-stage breast cancer attributed to absence of mammography

Kaiser Permanente researchers say increased communication is key to reaching women in need of screening

Denver, CO – The greatest risk associated with last-stage breast cancer among women in integrated health plans is not having a mammogram despite having access to the life-saving test, according to a new study in the October 20 issue of the Journal of the National Cancer Institute. The study also found that older, unmarried, less educated, and lower income women are less likely to be screened.

Kaiser Permanente Colorado researchers participated in the study that was conducted by scientists in the Cancer Research Network—a consortium of health care organizations nationwide that studies the effectiveness of cancer-control interventions.

The findings also spotlight the need for increased communication with all women of screening age. One reason women with late-stage breast cancer do not have mammograms is their own decision to not come in for the routine test. Kaiser Permanente Colorado has developed a communication tracking system that provides prompting for women who do not schedule their mammograms at recommended ages or who miss their scheduled appointment. Women aged 70 and older are encouraged to talk with their physicians and decide together on the need for a mammogram.

"Kaiser Permanente is committed to preventing breast cancer by supporting women in their need for breast cancer screening. By taking a hard look at our care, we can better assess where improvements need to be made," said Eric France, M.D., chief of preventive medicine.

How the research was conducted

To find out where the screening process breaks down and where changes in care might have the greatest impact, the researchers examined data from 2,694 women aged 50 years and older who had breast cancer and were members of integrated health plans that provide both primary and specialty care. They compared women who had been diagnosed with late-stage breast cancer with those who had been diagnosed with early-stage breast cancer and, on the basis of their care, categorized the women into groups.

absence of screening (when no mammogram existed)
absence of detection (when the earliest screening mammogram was negative
potential break down in follow-up

What the study found

The researchers found that 52 percent of the late-stage breast cancer cases were associated with an absence of screening, 39 percent with an absence of detection, and 8 percent with a potential breakdown in follow-up. They found that the odds of having late-stage cancer were nearly doubled among women with an absence of screening. Among women diagnosed with late-stage cancer, women were more likely to be in the absence-of-screening group if they were aged 75 years or older, unmarried, or did not have a family history of breast cancer. In addition, women who had less education or lower income were more likely to have been in the absence-of-screening group.

About the Cancer Research Network

The Cancer Research Network (CRN) is a consortium of 11 health care organizations that collaborate on studies of cancer epidemiology, prevention, early detection, and control in the context of health care delivery systems. Together, the participating organizations have access to health care data on 9 million people, or 3.5 percent of the U.S population. The CRN is supported by grants from the National Cancer Institute. Group Health Cooperative's Center for Health Studies provides scientific and administrative leadership for the network.

Laura Ichikawa, MS; Robin Altaras; Robert K. Beverly, MA; Deborah Casso, MPH; and Emily Oakes Westbrook, of Group Health Cooperative, Seattle, WA
Marianne Ulcickas Yood, PhD, of Henry Ford Health System, Detroit, MI
M. Michele Manos, PhD, and Wendy A. Leyden, MPH, of Kaiser Permanente Northern California, Oakland, CA
Ann M. Geiger, PhD, of Kaiser Permanente Southern California, Pasadena, CA
Sheila Weinmann, PhD, of Kaiser Permanente Northwest, Portland, OR
Joyce Gilbert, MPH, of Kaiser Permanente Hawaii, Honolulu, HI
Judy Mouchawar, MD, MPH, and Kimberly Bischoff, MS, of Kaiser Permanente Colorado, Denver, CO
Jane G. Zapka, ScD, of the University of Massachusetts Medical School, Worcester, MA
William E. Barlow, PhD, of Cancer Research and Biostatistics, Seattle, WA

For a copy of the study, contact Sarah Zielinski at the Journal of the National Cancer Institute at (301) 841-1285.

This study is among the more than 100 research projects conducted by the Kaiser Permanente Colorado Clinical Research Unit. The CRU develops, conducts and translates high-quality research into practice and works to promote evidence-based practices and service-oriented, cost-effective medical care. Investigators partner with prominent research institutions throughout the country including the Mayo Clinic, the U.S. Centers for Disease Control and Prevention and the National Institutes of Health.

Kaiser Permanente is a non-profit health plan and the largest private health care provider in Colorado. For the second year in a row, the National Committee for Quality Assurance has rated Kaiser Permanente Colorado among the top ten accredited health care organizations in the country for clinical quality. Kaiser Permanente cares for more than 417,000 members in the Denver/Boulder and Colorado Springs areas. Kaiser Permanente physicians and care teams focus on prevention as well as curing disease, all in an effort to help patients live well and thrive.