Purpose: We sought to examine associations of mammography utilization with comorbidities and functional limitations in older breast cancer survivors.
Methods: Female breast cancer survivors (N = 1064) identified in the 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS) who were aged ≥ 65 years were included for this study. Mammography use, major comorbidities (diabetes mellitus, myocardial infarction, coronary heart disease, stroke, chronic obstructive pulmonary disease, arthritis, chronic kidney disease, depression, and malignancy other than breast cancer), functional limitations (impairment of vision, audition, cognition, and mobility), and other covariates were measured by self-report. We used multivariable logistic regression models to calculate adjusted odds ratios (aOR) of comorbidities and functional limitations. Subgroup analyses were conducted by age (65-74 vs. ≥ 75 years) and survival time (< 10 vs. ≥ 10 years), and interactions were examined by Wald tests.
Results: Of the 1064 respondents, 841 (79.0%) had comorbidities, 418 (39.3%) had functional limitations, and 744 (69.9%) underwent mammography last year. Overall, the mean age was 73.8 years (SD = 5.1 years) and 91.4% were white. The multivariable model identified inverse associations with mammography use for functional limitations (≥ 2 vs. 0: aOR = 0.61, 95% CI = 0.39-0.95, p-trend = 0.09) but not comorbidities (≥ 2 vs. 0: aOR = 0.91, 95% CI = 0.61-1.35, p-trend = 0.62). The Wald test did not find any significant interaction.
Conclusions: A higher burden of functional limitations, not comorbidities, is associated with a lower rate of mammography use among older breast cancer survivors.
Implications for cancer survivors: Interventions are needed to individualize surveillance mammography among older breast cancer survivors based on their health status.
Keywords: Breast cancer survivor; Comorbidity and functional limitation; Epidemiology; Mammography.