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Who goes to the ER during treatment?
Lead author Dawn Hershman, MD, of Columbia University Medical Center in New York, and SWOG researchers, including Fred Hutch’s Unger and Barlow, also dug into data to see which elderly breast cancer patients had unplanned emergency room visits. Their retrospective analysis was presented during a spotlight poster discussion by Hershman during the conference.
The SWOG team set out to discover if insurance status might be a proxy for structural barriers to outpatient quality care, since many unplanned ER visits and hospitalizations are preventable. They first pooled breast cancer patients ages 65 and older who’d participated in SWOG clinical trials from 2001 to 2019, linking the trial data to the participants’ insurance claims (either Medicare alone, Medicare plus commercial insurance or Medicare plus Medicaid).
After examining just over a thousand patient records, they found patients with Medicare and Medicaid were much more likely to have an ER visit within 12 months of their clinical trial registration.
“Despite participation in a breast cancer clinical trial, patients with Medicare plus Medicaid had a two-fold increased risk of unplanned ER visits despite controlling for clinical, demographic and prognostic factors,” the team wrote in their analysis.
As Hershman explained in her presentation, the findings suggest that “access and structural factors may adversely influence unplanned emergency room visits for socioeconomically vulnerable old patients with breast cancer.”
In conjunction with reducing insurance-related barriers to clinical trials, she said efforts are needed to ensure adequate clinical resources for more vulnerable older patients in order to prevent unplanned use of acute care.
Dense breasts and elevated risk of cancer
Fred Hutch biostatistician and Rosalie and Harold Rea Brown Endowed Chair Ruth Etzioni, PhD, and researchers from three other institutions, shared data from a study regarding the association between dense breast tissue and breast cancer aimed at determining the true nature of this risk or whether it had been overstated.
“It’s well-known that women with dense breasts have a higher risk of breast cancer, but their process of diagnosis for them can be quite different than the process of women who don’t have dense breasts,” Etzioni said, explaining that women with dense breasts often have supplemental screening, such as ultrasound or MRI.
“We wanted to know the real risk because the more you look, the more you find,” she said. “Have we been looking so much more that we’ve exaggerated how high their risk is?”
The answer is no.
Etzioni and first author Jane Lange, PhD, from Oregon Health & Science University, used data from the Breast Cancer Surveillance Consortium, the leading collaborative network of U.S. breast imaging registries, to analyze mammogram and cancer outcomes in women aged 40 to 54 who had their first digital mammogram between the years 2000 and 2018. Out of a total of 33,542 women, 15,092 had non-dense breasts (meaning, they were almost entirely fatty or had scattered fibro glandular density). The remaining 18,450 had dense or extremely dense breasts.
After comparing the two groups, Etzioni said the data showed a robust increased risk of breast cancer among women with dense breasts.
“It’s a real increase in risk and not an artifact of the difference in what’s done to them,” she said. “It’s good for women to know if they have dense breasts. It’s an important piece of information to have in her health toolkit.”
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