PURPOSE We used the Surveillance Epidemiology and End Results (SEER)-Medicare database to explore the association between primary care and breast cancer outcomes.METHODS Using a retrospective cohort study of 105,105 female Medicare benefi ciaries with a diagnosis of breast cancer in SEER registries during the years 1994-2005, we examined the total number of offi ce visits to primary care physicians and non-primary care physicians in a 24-month period before cancer diagnosis. For women with invasive cancers, we examined the odds of diagnosis of late-stage disease, according to the American Joint Commission on Cancer (AJCC) (stages III and IV vs stages I and II), and survival (breast cancer specifi c and all cause) using logistic regression and proportional hazards models, respectively. We also explored whether including noninvasive cancers, such as ductal carcinoma in situ (DCIS), would alter results and whether prior mammography was a potential mediator of associations.RESULTS Primary care physician visits were associated with improved breast cancer outcomes, including greater use of mammography, reduced odds of latestage diagnosis, and lower breast cancer and overall mortality. Prior mammography (and resultant earlier stage diagnosis) mediated these associations in part, but not completely. Similar results were seen for non-primary care physician visits. Results were similar when women with DCIS were included in the analysis.CONCLUSIONS Medicare benefi ciaries with breast cancer had better outcomes if they made greater use of a primary care physician's ambulatory services. These fi ndings suggest adequate primary medical care may be an important factor in achieving optimal breast cancer outcomes.

The intervention increased use of hats among fourth-grade students at school but had no effect on self-reported wide-brimmed hat use outside of school or on measures of skin pigmentation.

Background Utilization of primary care may decrease colorectal cancer (CRC) incidence and death through greater receipt of CRC screening tests. Objective To examine the association of primary care utilization with CRC incidence, CRC deaths, and all-cause mortality. Design Population-based, case–control study. Setting Medicare program. Participants Persons aged 67 to 85 years diagnosed with CRC between 1994 and 2005 in U.S. Surveillance, Epidemiology, and End Results (SEER) regions matched with control patients (n = 205 804 for CRC incidence, 54 160 for CRC mortality, and 121 070 for all-cause mortality). Measurements Primary care visits in the 4- to 27-month period before CRC diagnosis, CRC incidence, CRC mortality, and all-cause mortality. Results Compared with persons having 0 or 1 primary care visit, persons with 5 to 10 visits had lower CRC incidence (adjusted odds ratio [OR], 0.94 [95% CI, 0.91 to 0.96]) and mortality (adjusted OR, 0.78 [CI, 0.75 to 0.82]) and lower all-cause mortality (adjusted OR, 0.79 [CI, 0.76 to 0.82]). Associations were stronger in patients with late-stage CRC diagnosis, distal lesions, and diagnosis in more recent years when there was greater Medicare screening coverage. Ever receipt of CRC screening and polypectomy mediated the association of primary care utilization with CRC incidence. Limitation This study used administrative data, which made it difficult to identify potential confounders and prevented examination of the content of primary care visits. Conclusion Medicare beneficiaries with higher utilization of primary care have lower CRC incidence and mortality and lower overall mortality. Increasing and promoting access to primary care in the United States for Medicare beneficiaries may help decrease the national burden of CRC. Primary Funding Source American Cancer Society.