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Utilization of bone mineral density testing among breast cancer survivors in British Columbia, Canada

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Abstract

Summary

Breast cancer survivors are at high osteoporosis risk. Bone mineral density testing plays a key role in osteoporosis management. We analyzed a historical utilization of bone mineral density testing in breast cancer survivors. The utilization remained low in the 1995–2008 period. Lower socio-economic status and rural residency were associated with lower utilization.

Introduction

To evaluate the utilization of bone mineral density (BMD) testing for female breast cancer survivors aged 65+ surviving ≥ 3 years in British Columbia, Canada.

Methods

A retrospecitve population-based data linkage study. Trends in proportion of survivors with ≥ 1 BMD test for each calendar year from 1995 to 2008 were evaluated with a serial cross-sectional analysis. Associations between factors (socio-demographic and clinical) and BMD testing rates over the period 2006–2008 for 7625 survivors were evaluated with a cross-sectional analysis and estimated as adjusted prevalence ratios (PRadj) using log-binomial models.

Results

Proportions of survivors with ≥ 1 BMD test increased from 1.0% in 1995 to 10.1% in 2008. The BMD testing rate in 2006–2008 was 26.5%. Socio-economic status (SES) and urban/rural residence were associated with BMD testing rates in a dose-dependent relationship (p for trend< 0.01). Survivors with lower SES (PRadj = 0.66–0.78) or rural residence (PRadj = 0.70) were 20–30% less likely to have BMD tests, compared with survivors with the highest SES or urban residence. BMD testing rates were also negatively associated with older age (75+) (PRadj = 0.47; 95% CI = 0.42, 0.52), nursing home residency (0.05; 0.01, 0.39), recent osteoporotic fractures (0.21; 0.14, 0.32), and no previous BMD tests (0.26; 0.23, 0.29).

Conclusion

Utilization of BMD testing was low for breast cancer survivors in BC, Canada. Lower SES and rural residence were associated with lower BMD testing rates.

Implication for cancer survivors

Female breast cancer survivors, especially those with lower SES or rural residence, should be encouraged to receive BMD tests as recommended by Canadian guidelines.

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Abbreviations

AIs:

aromatase inhibitors

APC:

annual percent change

AAPC:

average annual percent change

BC:

British Columbia

BCCA:

British Columbia Cancer Agency

BCOU:

Breast Cancer Outcomes Unit

BMD:

bone mineral density

CAROC:

Canadian Association of Radiologist and Osteoporosis Canada

DXA:

dual-energy X-ray absorptiometry

FRAX:

Fracture Risk Assessment Tool

ICD:

International Classification of Diseases

MSP:

Medical Service Plan

PCCF:

Postal Code Conversion File

PR:

prevalence ratio

SES:

socio-economic status

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

UBC:

University of British Columbia

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Acknowledgements

All inferences, opinions, and conclusions drawn in this report are those of the authors and do not reflect the opinions or policies of the data stewards. The first author, Dr. Olivia L. Tseng, was financially supported by the Clinician Scholarship through the Department of Family Practice of University of British Columbia and Telus-Canadian Breast Foundation National Fellowship.

Funding

This study was supported by a grant from the Canadian Breast Cancer Foundation.

Author information

Authors and Affiliations

  1. Cancer Control Research Program, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada

    O. L. Tseng, J. J. Spinelli, C. C. Gotay & M. L. McBride

  2. Department of Family Practice, University of British Columbia, 3rd floor David Strangway Building, 5950 University Boulevard Building, Vancouver, British Columbia, V6T 1Z3, Canada

    O. L. Tseng & M. G. Dawes

  3. School of Population and Public Health, University of British Columbia, Vancouver, Canada

    J. J. Spinelli, C. C. Gotay & M. L. McBride

Authors
  1. O. L. Tseng
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  2. M. G. Dawes
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  3. J. J. Spinelli
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  5. M. L. McBride
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Corresponding author

Correspondence to O. L. Tseng.

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Ethical approval

This study has been approved by the University of British Columbia/BC Cancer Agency Ethics Board (H09-01957).

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Tseng, O.L., Dawes, M.G., Spinelli, J.J. et al. Utilization of bone mineral density testing among breast cancer survivors in British Columbia, Canada. Osteoporos Int 28, 3439–3449 (2017). https://doi.org/10.1007/s00198-017-4218-6

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