Regular visits to primary care providers improve uptake of periodic mammograms, particularly as women age

Regular visits to primary care providers play an important role in a women’s uptake of periodic mammograms, and this association increases as women get older, says a new Ontario study from the Institute for Clinical Evaluative Sciences (ICES).

Canadian cancer screening guidelines for average-risk women recommend that all women 50 to 74 years of age be screened for breast cancer with mammography every 2 to 3 years. Despite these guidelines and the introduction of the Ontario Breast Screening Program in the early 1990s (providing women access to free breast screening without a doctor’s referral), many women who are eligible still do not get screened.

“Our study determined that women over the age of 65 who have not visited their primary care provider within a two-year period were less than half as likely to have received periodic mammograms,“ says study senior author Dr. Lawrence Paszat, a senior scientist at ICES and head of the Preventive Oncology Program at Sunnybrook Health Sciences Centre. “Our concern is that without regular screening these women may be at increased risk for a delayed breast cancer diagnosis, which can diminish their treatment options and outcomes.”

Published this month in the Journal of Medical Screening, this study is the first to examine the role of visits to primary care providers on the rate of periodic mammograms as women age.

The researchers reviewed the healthcare records of nearly 2.4 million Ontario women who were age 50 to 79 at any point between 2001 and 2010. Based on OHIP billing records, they determined whether or not a woman had visited a primary care provider within the previous two years. They further tracked the number and severity of other diagnoses, as well as the women’s ages and the income ranking of their postal code areas.

The study’s findings include:

• For women under 65 years of age, a woman who had visited her primary care provider within the previous two years was 1.68 times more likely to have had a periodic mammogram than a woman who had not.
• This difference was even more pronounced for women over the age of 65, with women 2.35 times more likely to have had a periodic mammogram if they’d visited their primary care providers within two years.
• Socioeconomics also appear to impact mammogram rates, with the rate of periodic mammograms 45 per cent lower among women from the poorest urban income quintile than women from the wealthiest urban income quintile.

"The importance of screening is generally well-accepted among primary care physicians in Ontario," says Dr. Paszat. "However, when a physician does not see a patient on a regular basis, it can be hard to establish a regular screening schedule. This study measures the extent of this screening barrier, demonstrating the continued importance of regular visits to primary care providers in ensuring the uptake of periodic mammograms, particularly as women become older.”

The researchers note that this study, which was conducted on behalf of the investigators of the Ontario Cancer Screening Research Network, can serve as a model for examining the links between primary care providers and other types of cancer screening, including cervix and colorectal cancer screening.

“The association between visiting a primary care provider and the uptake of periodic mammograms as women get older,” was published this month in the Journal of Medical Screening.

Author block: Rinku Sutradhar, Sumei Gu, Rick Glazier, Lawrence Paszat.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

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