Cancer Causes & Control

, Volume 16, Issue 7, pp 809–821

Inadequate Follow-up of Abnormal Screening Mammograms: Findings From the Race Differences in Screening Mammography Process Study (United States)

  • Beth A. Jones
  • Amy Dailey
  • Lisa Calvocoressi
  • Kam Reams
  • Stanislav V. Kasl
  • Carol Lee
  • Helen Hsu



Despite relatively high mammography screening rates, there are reports of inadequate follow-up of abnormal results. Our objective was to identify factors associated with inadequate follow-up, and specifically, to determine if this outcome differed by race/ethnicity.


We studied 176 subjects with abnormal or inconclusive mammograms identified from a prospective cohort study of African-American (n = 635) and White (n = 816) women who underwent screening in five hospital-based facilities in Connecticut, October 1996 through January 1998. Using multivariate logistic regression, we identified independent predictors of inadequate follow-up of an abnormal mammogram.


Over 28% of women requiring immediate or short-term follow-up did not receive this care within three months of the recommended return date. African-American race/ethnicity, pain during the mammogram, and lack of a usual provider were significant independent predictors of inadequate follow-up. Although many factors were examined, the observed race difference was unexplained.


While inadequate follow-up of abnormal exams undermines the potential benefits of mammography screening for all women, the observed race difference in this study may have implications for the persistent race difference in breast cancer stage at diagnosis and survival. More research is needed to identify factors that contribute to poor follow-up among African-American women.


abnormal results African-Americans follow-up health care delivery mammography screening 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jemal, A, Murray, T, Ward, E,  et al. 2005Cancer statistics, 2005CA Cancer J Clin551030PubMedGoogle Scholar
  2. 2.
    Gotzsche, PC, Olsen, O 2000Is screening for breast cancer with mammography justifiable?Lancet355129134CrossRefPubMedGoogle Scholar
  3. 3.
    Olsen, O, Gotzsche, PC 2001Cochrane review on screening for breast cancer with mammographyLancet35813401342CrossRefPubMedGoogle Scholar
  4. 4.
    Michaelson, JS, Satija, S, Kopans, D,  et al. 2003Gauging the impact of breast carcinoma screening in terms of tumor size and death rateCancer9821142124CrossRefPubMedGoogle Scholar
  5. 5.
    Smith, RA, Cokkinides, V, Eyre, HJ 2004American cancer society guidelines for the early detection of cancer, 2004CA Cancer J Clin544152PubMedGoogle Scholar
  6. 6.
    U.S. Preventive Services Task Force (2002) Screening for Breast Cancer: Recommendations and Rationale. Rockville, MD: Agency for Healthcare Research and Quality. Available at: Accessed March 8, 2004
  7. 7.
    National Cancer Institute (2002) NCI Statement on Mammography Screening. Available at:, Accessed March 8, 2004
  8. 8.
    Ward, E, Jemal, A, Cokkinides, V,  et al. 2004Cancer disparities by race/ethnicity and socioeconomic statusCA Cancer J Clin547893PubMedGoogle Scholar
  9. 9.
    Jones, B, Patterson, EA, Calvocoressi, L 2003Mammograpahy screening in African-American women: evaluating the researchCancer97(1 Suppl)258272CrossRefGoogle Scholar
  10. 10.
    Hunter, CP 2000Epidemiology, stage at diagnosis, and tumor biology of breast carcinoma in multiracial and multiethnic populationsCancer881193202CrossRefPubMedGoogle Scholar
  11. 11.
    Hunter, CP, Redmond, CK, Chen, VW,  et al. 1993Breast cancer: factors associated with stage at diagnosis in black and white women. Black/White Cancer Survival Study GroupJ Natl Cancer Inst8511291137PubMedGoogle Scholar
  12. 12.
    Jones, BA, Kasl, SV, Curnen, MG, Owens, PH, Dubrow, R 1995Can mammography screening explain the race difference in stage at diagnosis of breast cancer?Cancer7521032113PubMedGoogle Scholar
  13. 13.
    Jacobellis, J, Cutter, G 2002Mammography screening and differences in stage of disease by race/ethnicityAm J Public Health9211441150PubMedGoogle Scholar
  14. 14.
    McCarthy, EP, Burns, RB, Coughlin, SS,  et al. 1998Mammography use helps to explain differences in breast cancer stage at diagnosis between older black and white women (see comments)Ann 0Intern Med128729736Google Scholar
  15. 15.
    Webber, PA, Fox, P, Zhang, X, Pond, M 1996An examination of differential follow-up rates in breast cancer screeningJ Commu Health21123132CrossRefGoogle Scholar
  16. 16.
    Schootman, M, Myers-Geadelmann, J, Fuortes, L 2000Factors associated with adequacy of diagnostic workup after abormal breast cancer screening resultsJ Am Board Fam Practice1394100Google Scholar
  17. 17.
    Kerner, JF, Yedidia, M, Padgett, D,  et al. 2003Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black womenPrev Med3792101CrossRefPubMedGoogle Scholar
  18. 18.
    Burack, R, Simon, M, Stano, M, George, J, Coombs, J 2000Follow-up among women with an abnormal mammogram in an HMO: is it complete, timely, and efficientAm J Manag Care611021112PubMedGoogle Scholar
  19. 19.
    Caplan, L, May, D, Richardson, L 2000Time to Diagnosis and treatment of breast cancer: results from the national breast and cervical cancer early detection program, 1991-1995Am J Public Health90130133PubMedGoogle Scholar
  20. 20.
    Chang, S, Kerlikowske, K, Napoles-Springer, A 1996Racial differences in timeliness of follow-up after abnormal screening mammographyCancer Practice7813951402Google Scholar
  21. 21.
    McCarthy, B, Yood, M, Boohaker, E, Ward, R, Rebner, M, Johnson, C 1996Inadequate follow-up of abnormal mammogramsAm J Prev Med12282288PubMedGoogle Scholar
  22. 22.
    Yabroff, KR, Washington, KS, Leader, A, Neilson, E, Mandelblatt, J 2003Is the promise of cancer-screening programs being compromised? Quality of follow-up care after abnormal screening resultsMed Care Res Rev60294331CrossRefPubMedGoogle Scholar
  23. 23.
  24. 24.
    State of Connecticut Department of Economic and Community Development (1990) Connecticut Population Information. Available at: 250666. Accessed February 18, 2005
  25. 25.
    Jones, BA, Culler, CS, Kasl, SV, Calvocoressi, L 2001Is variation in quality of mammographic services race linked?J Health Care Poor Underserved12113126PubMedGoogle Scholar
  26. 26.
    American College of Radiology1998Breast imaging reporting and data system (BI-RADS®)3American College of RadiologyReston, VAGoogle Scholar
  27. 27.
    Duncan, OD 1961

    A socioeconomic index for all occupations.

    AJ, R eds. Occupations and Social StatusFree Press of GlencoeNew York109138
    Google Scholar
  28. 28.
    Stevens, GF 1981A revised socioeconomic index of occupational statusSoc Sci Res10364395CrossRefGoogle Scholar
  29. 29.
    National Institutes of Health1998Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults – The evidence reportObes Res651S209SGoogle Scholar
  30. 30.
    Holford, T. 2002Multivariate Methods in EpidemiologyOxford University PressNew York, NYGoogle Scholar
  31. 31.
    Greenland, S 1989Modeling and variable selection in epidemiological analysisAm J Epidemiol793409Google Scholar
  32. 32.
    Blackman, DK, Bennett, EM, Miller, DS 1999Trends in self-reported use of mammograms (1989–1997) and Papanicolaou tests (1991-1997)–Behavioral Risk Factor Surveillance SystemMMWR CDC Surveill Summ48122Google Scholar
  33. 33.
    Bastani, R, Yabroff, KR, Myers, RE, Glenn, B 2004Interventions to Improve Follow-Up of Abnormal Findings in Cancer ScreeningCancer101(5 Suppl)11881200CrossRefGoogle Scholar
  34. 34.
    Gregg, J, Curry, RH 1994Explanatory models for cancer among African-American women at two Atlanta neighborhood health centers: the implications for a cancer screening programSoc Sci Med3951926CrossRefPubMedGoogle Scholar
  35. 35.
    Davis, TC, Williams, MV, Marin, E, Parker, RM, Glass, J 2002Health literacy and cancer communicationCA Cancer J Clin52134149PubMedGoogle Scholar
  36. 36.
    Chen, VW, Correa, P, Kurman, RJ,  et al. 1994Histological characteristics of breast carcinoma in blacks and whitesCancer Epidemiol Biomarkers Prev3127135PubMedGoogle Scholar
  37. 37.
    Eley, JW, Hill, HA, Chen, VW,  et al. 1994Racial differences in␣survival from breast cancer. Results of the National Cancer␣Institute Black/White Cancer Survival StudyJAMA27294754CrossRefPubMedGoogle Scholar
  38. 38.
    Elledge, RM, Clark, GM, Chamness, GC, Osborne, CK 1994Tumor biologic factors and breast cancer prognosis among white, Hispanic, and black women in the United StatesJ Natl Cancer Inst86705712PubMedGoogle Scholar
  39. 39.
    Jones, B, Kasl, SV, Howe, CL,  et al. 2004African-American/white differences in breast cancer tumors: p53 alterations and other tumor characteristicsCancer10112931301CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Beth A. Jones
    • 1
  • Amy Dailey
    • 1
  • Lisa Calvocoressi
    • 1
  • Kam Reams
    • 1
  • Stanislav V. Kasl
    • 1
  • Carol Lee
    • 2
  • Helen Hsu
    • 1
    • 3
  1. 1.Department of Epidemiology and Public HealthYale University School of MedicineNew HavenUSA
  2. 2.Department of Diagnostic RadiologyYale University School of MedicineNew HavenUSA
  3. 3.Children’s Oncology GroupHelen HsuArcadiaUSA

Personalised recommendations