EVALUATION OF FACTORS POTENTIALLY ASSOCIATED WITH INADEQUATE FOLLOW-UP OF MAMMOGRAPHIC ABNORMALITIES

BACKGROUND. To increase the proportion of women who receive the recomm ended follow-up for mammographic abnormalities, factors which inhibit follow-up must he identified. Patient and health care delivery related factors were evaluated, stratified by type of follow-up recommendatio n, to determine reasons for inadequate follow-up. METHODS. All Caucasi an and African American women at the Henry Ford Medical Group, in sout heastern Michigan, with an abnormal screening mammogram result between January 1, 1992 and July 31, 1992 were identified. All women with ina dequate follow-up, and a random sample of women with adequate follow-u p, were invited to participate in a telephone interview that assessed three major dimensions of the Health Belief Model (susceptibility, ben efits, and barriers), general health and health behaviors, and related characteristics. The relationship between these factors and inadequat e follow-up was evaluated separately for women with immediate and 6-mo nth follow-up recommendations, using univariate and multivariate analy ses. RESULTS. A total of 555 women were invited to participate in the study (219 with inadequate follow-up and 336 with adequate follow-up). interviews were completed for 418 women (75.3%). Women who were not n otified of their mammographic abnormality were excluded from this stud y, leaving 399 women available for analysis. Among the women who had t he recommended immediate follow-up, those who reported difficulty in o btaining medical appointments were 4 times more likely to have inadequ ate follow-up (95% confidence interval [CI] 1.5, 11.3), after adjustin g for other variables. Among the women with six-month follow-up recomm ended, those who received fewer mammograms in the past 5 years were mo re likely to have inadequate follow-up (odds ratio [OR] = 4.0; 95% CI 1.6, 10.4). In this group, sociodemographic characteristics were not a ssociated with inadequate follow-up, although women with transportatio n problems were at a higher risk (crude OR = 5.2; 95% CI 1.6, 16.7; ad justed OR = 3.1; 95% CI 0.5, 18.3). Among women with B-month follow-up recommended, those who perceived their health as poor or fair (crude OR = 2.4; 95% CI 1.2, 5.1; adjusted OR = 2.3; 95% CI 0.8, 6.8) and tho se who did not examine their own breasts frequently (crude OR = 2.3; 9 5% CI 1.0, 5.4; adjusted OR = 2.7; 95% CI 0.5, 18.3) were also more li kely to have inadequate follow-up. CONCLUSIONS. Results from this stud y demonstrate that the relative importance of factors associated with inadequate follow-up of abnormal mammograms differs according to the t ype of follow-up recommended. For both types of recommendations, the f actors identified are noteworthy because they are amenable to interven tion. Efforts should be made to facilitate appointment scheduling for follow-up of abnormal mammograms, and information about previous mammo graphy screening should be obtained to identify women who are at a hig h risk for inadequate follow-up. (C) 1996 American Cancer Society.