Abstract
ObjectiveTo investigate mammography facilities’ follow‐up times, population vulnerability, system‐based processes, and association with cancer stage at diagnosis.Data SourcesProspectively collected from San Francisco Mammography Registry (SFMR) 2005‐2011, California Cancer Registry 2005‐2012, SFMR facility survey 2012.Study DesignWe 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 MethodsMerged SFMR, Cancer Registry and facility survey data.Principal FindingsFacilities (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).ConclusionsProviding mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow‐up and cancer diagnosis stage.
Highlights
More than 200 000 U.S women are diagnosed with, and approximately 40 000 die of, breast cancer annually.[1]
We examined whether facilities with longer follow-up times for BI-RADS 4 or 5 results serve a disproportionate number of vulnerable women compared with those with shorter follow-up times and further examined facility characteristics associated with longer follow-up times
We leveraged a unique dataset combining clinical data on thousands of women with abnormal mammogram results with information on the facilities serving those women to examine the relationship among follow-up time, processes of care, and the vulnerability of the populations served by the facilities
Summary
To investigate mammography facilities’ follow-up times, population vulnerability, system-b ased processes, and association with cancer stage at diagnosis. 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. Among women with a cancer diagnosis, we modeled odds of advanced-stage (≥IIb) cancer diagnosis by facility follow-up group. 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). 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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