Mammogram adherence after a rise in telehealth use: a longitudinal study of a large health system

Abstract

Objective: Early detection of breast cancer through routine screening improves survival. Increased engagement with healthcare services may promote mammography uptake. This study examined whether greater telehealth use is associated with higher mammogram screening rates.

Methods: We analyzed data from January 1st 2018 to December 31st 2023 from the MultiCare Health System in Washington State. For each year, we determined whether a patient received a screening mammogram during that year or the following year. We assessed the association between type of encounter (≥1 telehealth visit vs. in-person only vs. no encounters) and the likelihood of having a mammogram, adjusting for race/ethnicity, insurance type, age, and pre-/post-COVID-19 period.

Results: Among 140,390 female patients (609,061 patient-year observations), those with no encounters were least likely to undergo mammography. Women who used telehealth were less likely to be screened than those with in-person visits but more likely than those with no visits (rural: Odds Ratio (OR) = 0.50, 95 % Confidence Interval (CI) = 0.43,0.60; urban: OR = 0.68, 95 % CI = 0.65,0.70). Telehealth rose from 0.04 % to 4 % post-COVID-19, while mammography rates increased from 0 % to an average of 13 %.

Conclusions: Expanding telehealth access may increase routine mammography, particularly among previously unscreened populations.

Keywords: Breast Cancer; Mammography; Prevention; Rurality; Telehealth.

Fig. 1

Encounter patterns among 19,522 (93,153 patient-year observations) female patients aged 50 years or older with at least one encounter and no mammography during the pre-COVID period, between 2018 and 2023 at the MultiCare Health System in Washington State.

Fig. 2

Mammography uptake rates among 19,522 (93,153 patient-year observations) female patients aged 50 years or older with at least one encounter and no mammography during the pre-COVID period, between 2018 and 2023 at the MultiCare Health System in Washington State.