Interventions to improve follow-up of abnormal findings in cancer screening

Abstract

The potential reduction in morbidity and mortality through cancer screening cannot be realized without receipt of appropriate follow-up care for abnormalities identified via screening. In this paper, the authors critically examine the existing literature on correlates of receipt of appropriate follow-up care for screen-detected abnormalities, as well as the literature on interventions designed to increase rates of receipt of follow-up care. Lessons learned describe what is known and not known about factors that are related to or predict receipt of follow-up care.Similarly, effective interventions to increase follow-up are described and gaps identified. A conceptual model is developed that categorizes the health care system in the United States as comprising four levels: policy, practice, provider, and patient. Some patient-level factors that influence follow-up receipt are identified, but the lack of data severely limit the understanding of provider, practice, and A long the continuum from cancer screening through diagnosis, treatment, and rehabilitation, little attention has focused on intervening to assure timely, effective diagnosis once an abnormality has been identified. To achieve the goal of reducing cancer morbidity and mortality, it is imperative that patients receive timely and appropriate follow-up for detected abnormalities, as a prerequisite to appropriate treatment. Failure to obtain appropriate diagnostic services can have a significant effect on psychosocial sequelae, morbidity, and mortality, as well as cost implications for the individual and the health care system. A recent review of studies on follow-up of abnormal screening examinations reported that, in the majority of studies, fewer than 75% of patients receive adequate follow-up care. 1 The negative implications of failure to follow-up are substantial, especially at the population level.

Barriers to Full Colon Evaluation for a Positive Fecal Occult Blood Test

“…These include telephone and mailed reminders and educational interventions to address fear of cancer diagnosis (19). Myers et al (20) showed that a physician-based intervention of reminderfeedback and educational outreach improved the evaluation of positive FOBT.…”

Timeliness of Cervical Cancer Diagnosis and Initiation of Treatment in the National Breast and Cervical Cancer Early Detection Program

“…Failure to obtain appropriate diagnostic services can have a significant negative effect on health outcomes, as well as costs for both the individual and the healthcare system. 1 A systematic review of follow-up care after abnormal screening tests for cervical, breast, and colon cancer showed that < 75% of women received timely and appropriate follow-up care. 2 The proportion of women who were followed after abnormal Pap tests varies dramatically across studies, ranging from 7% to 73%.…”

Low-Income Women with Abnormal Breast Findings: Results of a Randomized Trial to Increase Rates of Diagnostic Resolution

“…Incomplete or delayed diagnostic resolution can result in larger tumors, locally advanced or metastatic cancer, costlier treatment options (1), higher recurrence rates (2,3), and lower 5-year survival rates (4)(5)(6)(7). However, little research has focused on improving timely resolution of abnormal findings (8). This is troublesome given that only about 75% of all patients in the general population and 50% to 70% of minority women who test positive on any screening test receive appropriate follow-up care (9,10).…”