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Effects of program scale-up on time to resolution for patients with abnormal screening mammography results

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Abstract

Purpose

Effects of geographic program expansion to rural areas on screening program outcomes are understudied. We sought to determine whether time-to-resolution (TTR) varied significantly by service delivery time period, location, and participant characteristics across 19 North Texas counties.

Methods

We calculated proportions undergoing diagnostic follow-up and resolved ≤ 60 days. We calculated median TTR for each time period and abnormal result BI-RADS 0, 4, 5. Cox proportional hazards regressions estimated time period and patient characteristic effects on TTR. Wilcoxon rank sum tests evaluated whether TTR differed between women who did or did not transfer between counties for services.

Results

TTR ranged from 14 to 17 days for BI-RADs 0, 4, and 5; 12.4% transferred to a different county, resulting in longer median TTR (26 vs. 16 days; p < .001). Of those completing follow-up, 92% were resolved ≤ 60 days (median 15 days). For BI-RAD 3, TTR was 208 days (including required 180 day waiting period). Follow-up was significantly lower for women with BI-RAD 3 (59% vs. 96%; p < .0001).

Conclusion

Expansion maintained timely service delivery, increasing access to screening among rural, uninsured women. Policies adding a separate quality metric for BI-RAD 3 could encourage follow-up monitoring to address lower completion and longer TTR among women with this result.

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Abbreviations

BCCS:

Breast and cervical cancer services (Texas’ NBCCEDP-funded program)

BSPAN:

Breast screening and patient navigation program

BI-RAD:

Breast imaging-reporting and data system

NBCCEDP:

National breast and cervical cancer early detection program

TTR:

Time to resolution

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Acknowledgments

This study was funded by the Cancer Prevention Research Institute of Texas (PP120097; PP150053; Lee), which has underwritten the BSPAN clinical screening and navigation program since 2009. Additional support was provided by the National Cancer Institute (5P30CA142543) to the Harold C. Simmons Comprehensive Cancer Center and National Institutes of Health (NCATS UL1TR001105) to the UT Southwestern Center for Translational Medicine. Drs. Lee and Tiro are also supported by funding from the Agency for Healthcare Research and Quality (R24 HS022418) to the UT Southwestern Center for Patient-Centered Outcomes Research. The authors thank Melanie Carithers and Early Detection Program colleagues at Moncrief Cancer Institute for their ongoing collaboration and dedication to patients, and the many county partner organizations.

Author information

Authors and Affiliations

  1. Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA

    Simon Craddock Lee, Robin T. Higashi, Joanne M. Sanders, Hong Zhu, Caroline Mejias, Keith E. Argenbright & Jasmin A. Tiro

  2. Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Drive, Dallas, TX, 75390, USA

    Simon Craddock Lee, Hong Zhu, Keith E. Argenbright & Jasmin A. Tiro

  3. Mount St. Mary’s University, 10 Chester Place, Los Angeles, CA, 90007, USA

    Stephen J. Inrig

  4. Moncrief Cancer Institute, 400 W. Magnolia Ave, Fort Worth, TX, 76104, USA

    Keith E. Argenbright

Authors
  1. Simon Craddock Lee
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  2. Robin T. Higashi
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  4. Hong Zhu
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  8. Jasmin A. Tiro
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Corresponding author

Correspondence to Simon Craddock Lee.

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Conflict of interest

All authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by UT Southwestern Institutional Review Board (STU 022012-009; PI: Lee).

Appendix

Appendix

See Table 3.

Table 3 Breast cancer screening continuum: analysis by screening test, result, and follow-up recommendations
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Lee, S.C., Higashi, R.T., Sanders, J.M. et al. Effects of program scale-up on time to resolution for patients with abnormal screening mammography results. Cancer Causes Control 29, 995–1005 (2018). https://doi.org/10.1007/s10552-018-1074-4

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  • DOI: https://doi.org/10.1007/s10552-018-1074-4

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