Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb;54 Suppl 1(Suppl 1):226-233.
doi: 10.1111/1475-6773.13083. Epub 2018 Nov 5.

Mammography facilities serving vulnerable women have longer follow-up times

Leah S Karliner  1   2 , Celia Kaplan  1   2 , Jennifer Livaudais-Toman  1   2 , Karla Kerlikowske  3   4
Affiliations

Mammography facilities serving vulnerable women have longer follow-up times

Leah S Karliner et al. Health Serv Res. 2019 Feb.

Abstract

Objective: To investigate mammography facilities' follow-up times, population vulnerability, system-based processes, and association with cancer stage at diagnosis.

Data sources: Prospectively collected from San Francisco Mammography Registry (SFMR) 2005-2011, California Cancer Registry 2005-2012, SFMR facility survey 2012.

Study design: We examined time to biopsy for 17 750 abnormal mammogram results (BI-RADS 4/5), categorizing eight facilities as short or long follow-up based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced-stage (≥IIb) cancer diagnosis by facility follow-up group.

Data extraction methods: Merged SFMR, Cancer Registry and facility survey data.

Principal findings: Facilities (N = 4) with short follow-up completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long follow-up (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long follow-up facilities. The long follow-up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow-up facility was associated with higher adjusted odds of advanced-stage cancer (OR 1.45; 95% CI 1.10-1.91).

Conclusions: Providing mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow-up and cancer diagnosis stage.

Keywords: abnormal mammogram; breast cancer; delay; facility characteristics; vulnerable populations.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1
Sources of data and measure derivation from merged dataset [Color figure can be viewed at http://www.wileyonlinelibrary.com/]
Figure 2
Figure 2
Time to biopsy after a BI‐RADS 4 or 5 mammogram result by short and long follow‐up facility group [Color figure can be viewed at http://www.wileyonlinelibrary.com/]
See this image and copyright information in PMC

References

    1. ACS . Cancer Facts & Figures 2016. 2016. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts.... Accessed March 3, 2018.
    1. Adams EK, Breen N, Joski PJ. Impact of the national breast and cervical cancer early detection program on mammography and pap test utilization among white, Hispanic, and African American women: 1996‐2000. Cancer. 2007;109(2 Suppl):348‐358. - PubMed
    1. Chang SW, Kerlikowske K, Napoles‐Springer A, Posner SF, Sickles EA, Perez‐Stable EJ. Racial differences in timeliness of follow‐up after abnormal screening mammography. Cancer. 1996;78(7):1395‐1402. - PubMed
    1. Chuang SC, Chen W, Hashibe M, Li G, Zhang ZF. Survival rates of invasive breast cancer among ethnic Chinese women born in East Asia and the United States. Asian Pac J Cancer Prev. 2006;7(2):221‐226. - PubMed
    1. Elmore JG, Nakano CY, Linden HM, Reisch LM, Ayanian JZ, Larson EB. Racial inequities in the timing of breast cancer detection, diagnosis, and initiation of treatment. Med Care. 2005;43(2):141‐148. - PubMed

Publication types

MeSH terms