Delay in Diagnostic Testing After Abnormal Mammography in Low-Income Women

Abstract

Purpose/Objectives To identify factors associated with diagnostic delay after an incomplete or abnormal mammogram among women participating in a state mammography screening program. Research Approach Retrospective case-control design using bivariate and multivariate logistic regression analyses to explore the associations between age, race, ethnicity, marital status, breast cancer history, and self-reported breast symptoms and delay. Setting A statewide program of free screening mammography for women who are under- or uninsured. Participants 11,460 women enrolled in a free, statewide screening program from 2002–2006. Methodologic Approach Using the Tennessee Breast and Cervical Cancer Screening Program database, further analyses were conducted. Main Research Variables The outcome measure was delay in completion of all diagnostic tests and was defined as women who did not complete testing within 60 days. Findings: Thirty-seven percent of women required follow-up, and of a subset used in the analysis, 30% experienced delay of more than 60 days. Controlling for marital status, age, and breast cancer history, women who experienced delay were more likely to be African American versus Caucasian (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.13, 1.85) or Hispanic (OR = 0.72, 95% CI = 0.55, 0.93) and to have self-reported breast symptoms (OR = 1.50, 95% CI = 1.27, 1.77). Conclusions In a sample of women with low income needing mammography follow-up, delay was associated with three intrapersonal variables, potentially reducing the effectiveness of mammography screening for women who were African American, or Hispanic, or had self-reported breast symptoms. Interpretation Nurses providing cancer screening examinations are uniquely positioned to assess the knowledge, beliefs, and resources of women using the program and to navigate women through barriers to completion. Knowledge of factors associated with delay is valuable for planning interventions and allocating program resources.

Race-Specific Impact of Natural History, Mammography Screening, and Adjuvant Treatment on Breast Cancer Mortality Rates in the United States

“…For example, women who experienced a delay between the time of mammogram and diagnosis or last diagnostic test ruling out cancer were found to be more likely to be Black than White (odds ratio 1.45; 95% confidence interval = 1.13, 1.85). (35)…”

Follow-Up of Abnormal Breast and Colorectal Cancer Screening by Race/Ethnicity

“…5, 6 Compared with whites, black and Hispanic women have lower likelihood of receiving follow-up for abnormal mammography. 7–16 Little data exist on racial/ethnic disparities in time to follow-up of abnormal fecal occult blood testing or fecal immunochemical tests (FOBT/FIT). 17 Comparisons across cancers may suggest processes that promote timely resolution of positive screening tests.…”

Neighborhood-level Influences on Delays in Diagnostic Follow-up from Mammography Screening in African-American Women: A Systematic Review

“…Previous research has found that race/ethnicity, age ≥ 40 years, lower levels of education and median household income, and lack of insurance, solely or in combination, were predictors of delays in diagnostic follow-up from abnormal MS in African-American women [4][5][6][7]. In Fair et al study of 76 medically-underserved women age >40 years with inadequate follow-up imaging or biopsy (≥ 6 months since mammogram results), 48% of African-American women perceived low benefits and high barriers to follow-up from screening and care, and reported a decrease in internal health locus of control.…”