Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, San Francisco, CA, USA.
Med Care. 2012 Feb;50(2):171-8. doi: 10.1097/MLR.0b013e31822dcf2d.
Breast cancer is frequently diagnosed after an abnormal mammography result. Language barriers can complicate communication of those results.
We evaluated the association of non-English language with delay in follow-up.
Retrospective cohort study of women at 3 mammography facilities participating in the San Francisco Mammography Registry with an abnormal mammogram result from 1997 to 2008. We measured median time from report of abnormal result to first follow-up test.
Of 13,014 women with 16,109 abnormal mammograms, 4027 (31%) had a non-English patient language. Clinical facilities differed in proportion of non-English speakers and in time to first follow-up test: facility A (38%; 25 d), facility B (18%; 14 d), and facility C (51%; 41 d). Most mammography examinations (67%) had breast imaging and reporting data system 0 (incomplete) assessment, requiring radiographic follow-up. At 30 days of follow-up, 67% of all English speakers with incomplete assessments had a follow-up examination compared with 50% of all non-English speakers (P<0.0001). The facility with the least delay and the lowest proportion of non-English speakers, had the biggest difference by language; compared with English speakers and adjusting for education, non-English speakers had twice the odds ratio of >30-day delay in follow-up (odds ratio=2.3; 95% confidence interval, 1.4-3.9).
There are considerable differences among facilities in delays in diagnostic follow-up of abnormal mammography results. More attention must be paid to understanding mammography facility factors, such as wait time to schedule diagnostic mammography and radiology workload, to improve rates of timely follow-up, particularly for those facilities disproportionately serving vulnerable non-English speaking patients.
乳腺癌通常是在异常乳房 X 光检查结果后确诊的。语言障碍可能会使这些结果的沟通变得复杂。
我们评估了非英语语言与随访延迟之间的关联。
这是一项回顾性队列研究，研究对象为来自 1997 年至 2008 年期间在旧金山乳房 X 光检查登记处的 3 家乳房 X 光检查机构中接受异常乳房 X 光检查结果的女性。我们测量了从报告异常结果到首次随访检查的中位时间。
在 13014 名患有 16109 次异常乳房 X 光检查的女性中，有 4027 名（31%）患者的母语为非英语。临床机构在非英语患者的比例和首次随访检查的时间上存在差异：机构 A（38%；25 天）、机构 B（18%；14 天）和机构 C（51%；41 天）。大多数乳房 X 光检查（67%）有乳房成像和报告数据系统 0（不完整）评估，需要进行放射学随访。在 30 天的随访中，所有不完整评估的英语患者中有 67%接受了随访检查，而所有非英语患者中有 50%（P<0.0001）。延迟最短、非英语患者比例最低的机构，语言差异最大；与英语患者相比，并调整了教育因素，非英语患者在 30 天后延迟随访的可能性是英语患者的两倍（优势比=2.3；95%置信区间，1.4-3.9）。
在异常乳房 X 光检查结果的诊断性随访中，各机构之间存在相当大的差异。必须更加关注理解乳房 X 光检查机构的因素，如安排诊断性乳房 X 光检查的等待时间和放射科工作量，以提高及时随访的比率，特别是对那些不成比例地为弱势非英语患者服务的机构。
