Breast Cancer Follow-Up Exams Influenced by Social Determinant Factors

In a study of women whose mammogram results were probably normal but included a small chance of cancer, only about three of four received appropriate follow-up three to nine months after their exam. The analysis of about 3,000 women who scored 3 on the 6-point Breast Imaging Reporting and Database System showed that women who previously received cancer treatment were most likely to receive appropriate follow-up. Researchers concluded future interventions should target women less likely to receive follow-up, including those who are younger, unmarried, Hispanic, lacking insurance and without a history of breast cancer. Access the abstract of the study, published in the Journal of the American College of Radiology.

2019 Oct 26. pii: S1546-1440(19)31191-3. doi: 10.1016/j.jacr.2019.10.003. [Epub ahead of print]

Factors Associated With Optimal Follow-up in Women with BI-RADS 3 Breast Findings.

Lacson R1, Wang A2, Cochon L2, Giess C3, Desai S4, Eappen S5, Khorasani R3.

Author information

1: Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: rlacson@rics.bwh.harvard.edu.
2: Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
3: Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
4: Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
5: Harvard Medical School, Boston, Massachusetts; Department of Anesthesiology, Brigham and Women's Hospital, Boston, Massachusetts.

Abstract

OBJECTIVE:

Assess rate of and factors associated with optimal follow-up in patients with BI-RADS 3 breast findings.

METHODS:

This Institutional Review Board-approved, retrospective cohort study, performed at an academic medical center, included all women undergoing breast imaging (ultrasound and mammography) in 2016. Index reports for unique patients with an assessment of BI-RADS 3 (retrieved via natural language processing) comprised the study population. Patient-specific and provider-related features were extracted from the Research Data Warehouse. The Institutional Cancer Registry identified patients diagnosed with breast cancer. Optimal follow-up rate was calculated as patients with follow-up imaging on the same breast 3 to 9 months from the index examination among patients with BI-RADS 3 assessments. Univariate analysis and multivariable logistic regression determined features associated with optimal follow-up. Malignancy rate and time to malignancy detection was recorded.

RESULTS:

Among 93,685 breast imaging examinations, 64,771 were from unique patients of which 2,967 had BI-RADS 3 findings (4.6%). Excluding patients with off-site index examinations and those with another breast examination <3 months from the index, 1,125 of 1,511 patients (74%) had optimal follow-up. In univariate and multivariable analysis, prior breast cancer was associated with optimal follow-up; younger age, Hispanic ethnicity, divorced status, and lack of insurance with not having optimal follow-up. Malignancy rate was 0.86%, and mean time to detection to 330 days.

DISCUSSION:

Follow-up of BI-RADS 3 breast imaging findings is optimal in only 74% of women. Further interventions to promote follow-up should target younger, unmarried women, those with Hispanic ethnicity, and women without history of breast cancer and without insurance coverage.