Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.
MD/MPH Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J Gen Intern Med. 2022 May;37(7):1619-1625. doi: 10.1007/s11606-021-07189-3. Epub 2022 Feb 25.
Mobile mammographic services (MM) have been shown to increase breast cancer screening in medically underserved women. However, little is known about MM patients' adherence to follow-up of abnormal mammograms and how this compares with patients from traditional, fixed clinics.
To assess delays in follow-up of abnormal mammograms in women screened using MM versus fixed clinics.
Electronic medical record review of abnormal screening mammograms.
Women screened on a MM van or at a fixed clinic with an abnormal radiographic result in 2019 (N = 1,337).
Our outcome was delay in follow-up of an abnormal mammogram of 60 days or greater. Guided by Andersen's Behavioral Model of Health Services Utilization, we assessed the following: predisposing (age, ethnicity, marital status, preferred language), enabling (insurance, provider referral, clinic site), and need (personal breast cancer history, family history of breast/ovarian cancer) factors.
Only 45% of MM patients had obtained recommended follow-up within 60 days of an abnormal screening compared to 72% of fixed-site patients (p < .001). After adjusting for predisposing, enabling, and need factors, MM patients were 2.1 times more likely to experience follow-up delays than fixed-site patients (CI: 1.5-3.1; p < .001). African American (OR: 1.5; CI: 1.0-2.1; p < .05) and self-referred (OR: 1.8; CI: 1.2-2.8; p < .01) women were significantly more likely to experience delays compared to Non-Hispanic White women or women with a provider referral, respectively. Women who were married (OR: 0.63; CI: 0.5-0.9; p < .01), had breast cancer previously (OR: 0.37; CI: 0.2-0.8; p < .05), or had a family history of breast/ovarian cancer (OR: 0.76; CI: 0.6-0.9; p < .05) were less likely to experience delayed care compared to unmarried women, women with no breast cancer history, or women without a family history of breast/ovarian cancer, respectively.
A substantial proportion of women screened using MM had follow-up delays. Women who are African American, self-referred, or unmarried are particularly at risk of experiencing delays in care for an abnormal mammogram.
移动乳腺 X 光服务（MM）已被证明可以增加医疗服务不足的女性进行乳腺癌筛查。然而，对于 MM 患者对异常乳腺 X 光检查的后续随访的了解甚少，并且与传统固定诊所的患者相比如何，这方面的了解很少。
评估使用 MM 与固定诊所筛查的异常乳腺 X 光检查的后续随访中的延迟。
对 2019 年在 MM 车或固定诊所接受异常筛查乳腺 X 光检查的女性进行电子病历回顾。
在 2019 年，有 1337 名女性在 MM 车上或在固定诊所进行筛查，结果显示乳腺 X 光检查异常（N=1337）。
我们的结果是异常乳腺 X 光检查的随访延迟 60 天或更长时间。根据安德森健康服务利用行为模型，我们评估了以下因素：倾向因素（年龄、种族、婚姻状况、首选语言）、促成因素（保险、医生推荐、诊所地点）和需要因素（个人乳腺癌病史、乳腺癌/卵巢癌家族史）。
只有 45%的 MM 患者在异常筛查后 60 天内获得了推荐的随访，而固定部位患者的比例为 72%（p<0.001）。在调整了倾向、促成和需要因素后，MM 患者的随访延迟风险是固定部位患者的 2.1 倍（CI：1.5-3.1；p<0.001）。与非西班牙裔白人女性相比，非洲裔美国女性（OR：1.5；CI：1.0-2.1；p<0.05）和自我推荐的女性（OR：1.8；CI：1.2-2.8；p<0.01）更有可能出现延误。与有医生推荐的女性相比，已婚（OR：0.63；CI：0.5-0.9；p<0.01）、以前患有乳腺癌（OR：0.37；CI：0.2-0.8；p<0.05）或有乳腺癌/卵巢癌家族史（OR：0.76；CI：0.6-0.9；p<0.05）的女性不太可能出现延迟护理。
相当一部分接受 MM 筛查的女性存在后续随访延迟的情况。非洲裔美国女性、自我推荐或未婚的女性尤其有出现异常乳腺 X 光检查后续护理延迟的风险。
