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. 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.

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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

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