Time to Diagnostic Evaluation After Mammographic Screening in an Urban Setting

J Womens Health (Larchmt). 2016 Dec;25(12):1225-1230. doi: 10.1089/jwh.2015.5661. Epub 2016 May 16.

Abstract

Background: The Capital Breast Care Center (CBCC), a screening facility established to serve minority women, developed a culturally sensitive patient care paradigm that would address concerns of adherence to follow-up of abnormal results after initial mammogram. Women with abnormal mammograms are assigned a Black or Latina navigator who facilitates the additional workup needed by scheduling follow-up, arranging transportation, providing counsel/emotional support, and even accompanying them to diagnostic imaging or biopsy appointment. We present data on follow-up rates after breast cancer screening.

Methods: All patients seen at CBCC are entered into a prospectively collected database. We calculated intervals (in days) between the screening and diagnostic visits. Descriptive statistics and median time to follow-up are reported. Differences between Black and Hispanic women on time interval were tested by t-test.

Results: From January 2010 to December 2012, 4605 digital screening mammograms were performed. Fifty-two percent of the women self-identified as Black, 41% as Hispanic, 4% White, 2% Asian, and 1% as "other." Of the screening studies, 451 (9.8%) required additional workup, out of which 362 (80%) of the women returned for the recommended diagnostic imaging. The median interval between screening and diagnostic imaging was 39 days (range: 6-400). Of the 162 women recommended to have a core needle biopsy, 81.5% underwent biopsy within a median of 21 days (range: 0-221 days).

Conclusion: At the CBCC, time to patient follow-up after initial mammographic screening is within the CDC-recommended performance standard of less than 60 days. For a population that historically has low rates of clinical follow-up, we attribute this reduction in delays to breast cancer diagnostic resolution to a culturally sensitive patient navigation program. Additional studies are needed to assess how the existing navigation program can be individualized/tailored to target the remaining 20% of women who did not adhere to the recommended workup.

Keywords: breast cancer; diagnostic; minority health; patient navigation; screening mammography.

MeSH terms

  • Black or African American / statistics & numerical data
  • Breast Neoplasms / diagnosis*
  • Breast Neoplasms / prevention & control
  • Continuity of Patient Care*
  • Delivery of Health Care / organization & administration*
  • Early Detection of Cancer
  • Female
  • Follow-Up Studies
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Mammography*
  • Mass Screening
  • Minority Health
  • Patient Compliance
  • Patient Navigation*
  • Patient-Centered Care
  • Prospective Studies
  • Socioeconomic Factors
  • Time Factors
  • Time-to-Treatment*
  • Urban Population* / statistics & numerical data