Time to follow-up of an abnormal mammogram in women with diabetes: a population-based study.

Syed Yaser Habeeb,Kinwah Fung,Hadas D Fischer,Peter C Austin,Lorraine L Lipscombe,Lawrence Paszat

doi:10.1002/cam4.892

Abstract

Women with diabetes have a higher breast cancer incidence and mortality. They are also significantly less likely to undergo screening mammography and present with more advanced stage than women without diabetes. The purpose of this study was to examine if women with diabetes are more likely to have delays in follow‐up of abnormal mammograms, compared to women without diabetes. Using population‐based health databases, this retrospective cohort study examined women between the ages of 50 and 74, with and without diabetes, living in the province of Ontario, Canada, who underwent screening through a centralized program and who had an abnormal mammogram between 2003 and 2012. We compared rates of follow‐up of a diagnostic test within 180 days, as well as likelihood of mastectomy or excision procedure and a diagnosis of breast cancer. Following an abnormal screening mammogram, 97.5% of women with diabetes had a diagnostic procedure within 180 days compared to 97.9% of women without diabetes. After adjustment for other factors, women with diabetes were only 3% less likely to have follow‐up testing after an abnormal mammogram than women without diabetes (hazard ratio [HR] 0.97, 95% CI: 0.96–0.99, P < 0.001). The majority of Ontario women who underwent screening mammography through a centralized screening program had timely follow‐up of an abnormal mammogram, with no meaningful delays in those who had diabetes. The results of this study suggest that diagnostic delays after screening do not significantly contribute to higher breast cancer mortality in women with diabetes.

Highlights

Evidence suggests that women with diabetes are more likely to be diagnosed with postmenopausal breast cancer, present at an advanced stage, and have increased all-cause mortality after being diagnosed with breast cancer, compared to women without diabetes [1,2,3,4,5,6]
This large, population-b ased study examined whether delays in follow-u p of abnormal mammograms in women with diabetes might contribute to this excess mortality
In a universal health care setting among women undergoing screening mammography through a centralized program, we found that over 95% of women had appropriate follow-up of an abnormal test within 6 months and 50% of tests done within 14 days

Summary

Introduction

Evidence suggests that women with diabetes are more likely to be diagnosed with postmenopausal breast cancer, present at an advanced stage, and have increased all-cause mortality after being diagnosed with breast cancer, compared to women without diabetes [1,2,3,4,5,6]. Effective screening has been shown to decrease breast cancer mortality in postmenopausal women, those with diabetes are less likely to undergo regular mammograms [7,8,9,10,11]. Time to Follow-Up of Abnormal Mammograms manner in order for the screening to be considered effective. Delays in follow-up and diagnosis are associated with an increase in rate of cancer progression and decrease in survival [12,13,14]. While several studies have shown lower rates of mammograms in women with diabetes, no study to our knowledge has examined whether diabetes is a barrier for adequate follow-up of abnormal mammograms [7, 8, 11, 31, 32]

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