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Research ArticleOriginal Article

Factors Associated With Adequacy of Diagnostic Workup After Abnormal Breast Cancer Screening Results

Mario Schootman, Jill Myers-Geadelmann and Laurence Fuortes
The Journal of the American Board of Family Practice March 2000, 13 (2) 94-100; DOI: https://doi.org/10.3122/15572625-13-2-94
Mario Schootman
From the Division of Health Behavior Research (MS), Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, and The Alvin J. Site-man Cancer Center at Barnes-Jewish Hospital (MS), St Louis, Mo; the Bureau of Health Promotion (MS, JM-G), Iowa Department of Public Health. Des Moines; and the Department of Epidemiology (LF), College of Public Health, The University of Iowa, Iowa City, Iowa.
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Jill Myers-Geadelmann
From the Division of Health Behavior Research (MS), Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, and The Alvin J. Site-man Cancer Center at Barnes-Jewish Hospital (MS), St Louis, Mo; the Bureau of Health Promotion (MS, JM-G), Iowa Department of Public Health. Des Moines; and the Department of Epidemiology (LF), College of Public Health, The University of Iowa, Iowa City, Iowa.
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Laurence Fuortes
From the Division of Health Behavior Research (MS), Departments of Internal Medicine and Pediatrics, Washington University School of Medicine, and The Alvin J. Site-man Cancer Center at Barnes-Jewish Hospital (MS), St Louis, Mo; the Bureau of Health Promotion (MS, JM-G), Iowa Department of Public Health. Des Moines; and the Department of Epidemiology (LF), College of Public Health, The University of Iowa, Iowa City, Iowa.
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Abstract

Background: Women with certain characteristics, such as those residing in rural areas, are less likely screened for breast cancer. To enhance detection of early breast cancer, it is imperative that all women who have abnormal screening results receive appropriate diagnostic procedures. This study reports differences in receipt of diagnostic services following abnormal screening results.

Methods: Screening and diagnostic data were collected as part of a breast and cervical cancer early detection program aimed at reaching women of lower socioeconomic status. Women with completed diagnostic information after having abnormal screening results were included. We based adequacy of diagnostic services on guidelines from the Society for Surgical Oncology, The Commission on Cancer of the American College of Surgeons, and the Centers for Disease Control and Prevention. Several factors were assessed for their association with adequacy of diagnostic follow-up: income, age, race, education, health insurance status, rural-urban residence, reported breast lump, family history of breast cancer, and clinical beast examination or mammogram results.

Results: Overall, 14.1% of the 351 abnormal findings were considered inadequately followed up based on the algorithm used. Eighty percent involved an abnormal finding on a clinical breast examination regardless of the mammogram results. Rural women, those with abnormal clinical breast examination findings but normal or equivocal findings on mammograms, and those who self-discovered a mass were less likely to receive adequate follow-up than were their counterparts in multivariate analysis. Rural women were less likely to receive a biopsy or fine-needle aspiration, although it was indicated. One facility accounted for most of the inadequate follow-up screenings among urban women.

Conclusions: Women who have specific demographic and clinical characteristics were less likely to have received adequate diagnostic services. Breast cancers could have been missed initially as a result of inappropriate follow-up. Further investigation of the clinical scenarios using chart reviews is warranted.

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The Journal of the American Board of Family     Practice: 13 (2)
The Journal of the American Board of Family Practice
Vol. 13, Issue 2
1 Mar 2000
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Factors Associated With Adequacy of Diagnostic Workup After Abnormal Breast Cancer Screening Results
Mario Schootman, Jill Myers-Geadelmann, Laurence Fuortes
The Journal of the American Board of Family Practice Mar 2000, 13 (2) 94-100; DOI: 10.3122/15572625-13-2-94

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Factors Associated With Adequacy of Diagnostic Workup After Abnormal Breast Cancer Screening Results
Mario Schootman, Jill Myers-Geadelmann, Laurence Fuortes
The Journal of the American Board of Family Practice Mar 2000, 13 (2) 94-100; DOI: 10.3122/15572625-13-2-94
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