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. 2018 Oct;29(10):995-1005.
doi: 10.1007/s10552-018-1074-4. Epub 2018 Aug 23.

Effects of program scale-up on time to resolution for patients with abnormal screening mammography results

Simon Craddock Lee  1   2 , Robin T Higashi  3 , Joanne M Sanders  3 , Hong Zhu  3   4 , Stephen J Inrig  5 , Caroline Mejias  3 , Keith E Argenbright  3   4   6 , Jasmin A Tiro  3   4
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Effects of program scale-up on time to resolution for patients with abnormal screening mammography results

Simon Craddock Lee et al. Cancer Causes Control. 2018 Oct.

Abstract

Purpose: Effects of geographic program expansion to rural areas on screening program outcomes are understudied. We sought to determine whether time-to-resolution (TTR) varied significantly by service delivery time period, location, and participant characteristics across 19 North Texas counties.

Methods: We calculated proportions undergoing diagnostic follow-up and resolved ≤ 60 days. We calculated median TTR for each time period and abnormal result BI-RADS 0, 4, 5. Cox proportional hazards regressions estimated time period and patient characteristic effects on TTR. Wilcoxon rank sum tests evaluated whether TTR differed between women who did or did not transfer between counties for services.

Results: TTR ranged from 14 to 17 days for BI-RADs 0, 4, and 5; 12.4% transferred to a different county, resulting in longer median TTR (26 vs. 16 days; p < .001). Of those completing follow-up, 92% were resolved ≤ 60 days (median 15 days). For BI-RAD 3, TTR was 208 days (including required 180 day waiting period). Follow-up was significantly lower for women with BI-RAD 3 (59% vs. 96%; p < .0001).

Conclusion: Expansion maintained timely service delivery, increasing access to screening among rural, uninsured women. Policies adding a separate quality metric for BI-RAD 3 could encourage follow-up monitoring to address lower completion and longer TTR among women with this result.

Keywords: Breast cancer screening; Quality; Rural; Scale-up.

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Conflict of interest statement

All authors declare no conflicts of interest

Figures

Figure 1.
Figure 1.
Consort diagram of BSPAN participants selected for analysis
Figure 2.
Figure 2.
Time to Resolution by Time Period
Figure 3.
Figure 3.. Time to Resolution by Type of Abnormal Result.
The American Cancer Society recommends that patients who receive a BI-RAD 3 screening result undergo repeat short-interval (within 6–9 months) follow-up imaging.(30) Therefore we would expect that by 180 days following an abnormal result the women with a BI-RAD 3 result would start to reach the same proportion resolved as the women with BI-RAD 0, 4, 5 and Screening-Abnormal results.
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