INADEQUATE FOLLOW-UP OF ABNORMAL MAMMOGRAMS

Routine mammographic screening increases detection of nonpalpable brea st cancer. Timely follow-up of abnormalities is essential because dela ys may lead to postponement of treatment and decreased survival for wo men who have cancer. The purpose of this study was to determine the pe rcentage of women with an abnormal mammogram who do not have adequate follow-up and to determine factors associated with inadequate follow-u p. The study was conducted in a metropolitan health system that includ es a large urban teaching hospital in Detroit and 26 ambulatory care c enters. From the radiology database, all women with an abnormal screen ing mammogram performed between January 1, 1992, and July 31, 1992 wer e identified. We defined adequate follow-up as follow-up within three months of due date. Follow-up status was determined using medical reco rds and telephone interviews. The percentage of women with inadequate follow-up was calculated. Relative risks compared percentages of women with inadequate follow-up according to demographic and screening-rela ted variables. We calculated adjusted relative risks using multivariat e binomial regression. We identified 1,249 women with abnormal screeni ng mammograms. Inadequate follow-up occurred for 226 (18.1%) of the wo men. Among women with follow-up recommended in 4-6 months, 36.8% had i nadequate follow-up. among women with immediate follow-up recommended (obtain additional views or outside films for comparison, ultrasound, biopsy, or surgical referral), 7.2% had inadequate follow-up. Inadequa te follow-up was associated with lower estimated household income and no history of previous mammogram. Among women with inadequate follow-u p who were interviewed, 87% reported that they had been notified of th eir results. We found that the percentage of women with inadequate fol low-up of abnormal mammograms is high, especially among women who requ ire six-month follow-up. Women with low income and no history of a pre vious mammogram were at greatest risk for inadequate follow-up. These results document a previously unrecognized problem with mammography sc reening and suggest that the implementation of tracking systems to ens ure timely follow-up of abnormal screening mammograms is essential.