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Factors Associated with Cancer Prevention Surgeries for Hereditary Cancer Risk in Arkansas 2013-2018

Speaker(s)

Peng C1, Zorn KK2, Acharya M1, Bimali M3, Martin BC1
1University of Arkansas for Medical Sciences College of Pharmacy, Little Rock, AR, USA, 2University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, USA, 3University of Arkansas for Medical Sciences, Little Rock, AR, USA

Presentation Documents

OBJECTIVES: To identify the demographic, geographic, clinical, and health system factors associated with the use of mastectomy and salpingo-oophorectomy for cancer prevention among persons diagnosed with hereditary susceptibility to breast and ovarian cancer.

METHODS: Claims records from January 2013 through June 2018 (commercial, state employee and Medicaid), or December 2016 (Medicare) from the Arkansas All-Payer Claims Database were used to identify enrollees with genetic susceptibility to breast and ovarian cancer. The index date was the first claim with a diagnosis of genetic susceptibility to cancer. Individuals with ≥180 days of continuous enrollment for both pharmacy and medical benefits before and 1 day after the index date were analyzed. Enrollees were followed until preventive surgery, study end date or loss of enrollment. Covariates were assessed in the 180-day pre-index period. Cox Proportional Hazards models were estimated to identify factors associated with receipt of cancer prevention surgery.

RESULTS: There were 836 individuals in the breast cancer naïve cohort and 266 in the ovarian cancer naïve cohort. Among breast cancer naïve enrollees, 97 (11.60%) underwent mastectomy and 80 (9.57%) underwent salpingo-oophorectomy. Age was the only factor associated with salpingo-oophorectomy (HR=0.81; 95%CI:0.67-0.97), while Medicare coverage (HR=0.23; 95%CI:0.09-0.61) and geographical region were associated with mastectomy. Among ovarian cancer naïve patients, 42 (15.79%) underwent mastectomy and 99 (37.22%) underwent salpingo-oophorectomy. Age was the only factor associated with mastectomy (HR=0.66; 95%CI:0.49-0.90), while prior breast cancer diagnosis (HR=2.22; 95%CI:1.40-3.53) and year of genetic susceptibility to ovarian cancer were associated with salpingo-oophorectomy.

CONCLUSIONS: Roughly 10% of enrollees with genetic susceptibility to cancer who were breast cancer naïve underwent mastectomy or salpingo-oophorectomy, while those who were ovarian cancer naïve more often underwent mastectomy (16%) or salpingo-oophorectomy (37%). Younger women diagnosed with genetic cancer susceptibility were more likely to undergo cancer prevention surgery than their older counterparts.

Code

EPH111

Topic

Clinical Outcomes, Real World Data & Information Systems, Study Approaches

Topic Subcategory

Health & Insurance Records Systems, Performance-based Outcomes

Disease

Surgery