Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru.
BMJ Open. 2022 Apr 29;12(4):e050457. doi: 10.1136/bmjopen-2021-050457.
This mixed-method study aimed to understand the effectiveness of linkage to biopsy and treatment in women with a high-risk mammography result (Breast Imaging Reporting and Data System, BI-RADS 4 and 5) in the national telemammography programme and to explore women's experiences during this process.
Quantitative component: we collected and linked health data from the telemammography reading centre, the national public health insurance, the national centre for disease control and the national referral cancer centre. Qualitative component: we interviewed participants from different regions of the country representing diverse social and geographical backgrounds.
Quantitative: women who underwent telemammography between July 2017 and September 2018 and had high-risk results (BI-RADS 4-5) were collected. Qualitative: women with a high-risk telemammography result, healthcare providers and administrators.
Quantitative: we determined biopsy and treatment linkage rates and delays. Qualitative: we explored barriers and facilitators for obtaining a biopsy and initiating treatment.
Of 126 women with high-risk results, 48.4% had documentation of biopsy and 37.5% experienced a delay of >45 days to biopsy. Of 51 women diagnosed with breast cancer, 86.4% had evidence of treatment initiation, but 69.2% initiated treatment >45 days after biopsy. Travelling to major cities for care, administrative factors and breast cancer misconceptions, among other factors, impeded timely, continuous care for breast cancer. A multidisciplinary and culturally tailored patient education facilitated understanding of the disease and prompt decision making about subsequent medical care.
Strengthened breast cancer care capacity outside the capital city, standardised referral pathways, ensured financial support for travel expenses, and enhanced patient education are required to secure linkage to the breast cancer care continuum. Robust information systems are needed to track patients and to evaluate the programme's performance.
本混合方法研究旨在了解国家远程乳腺摄影计划中高风险乳腺 X 线摄影结果（乳腺影像报告和数据系统，BI-RADS 4 和 5）女性进行活检和治疗的效果，并探讨女性在此过程中的体验。
定量部分：我们从远程乳腺 X 线摄影阅读中心、国家公共卫生保险、国家疾病控制中心和国家转诊癌症中心收集和链接健康数据。定性部分：我们采访了来自全国各地、具有不同社会和地理背景的参与者。
定量：收集了 2017 年 7 月至 2018 年 9 月间进行远程乳腺 X 线摄影且结果为高风险（BI-RADS 4-5）的女性。定性：高风险远程乳腺 X 线摄影结果的女性、医疗保健提供者和管理人员。
在 126 名高风险结果的女性中，48.4%有活检记录，37.5%活检延迟>45 天。在 51 名被诊断患有乳腺癌的女性中，86.4%有治疗开始的证据，但 69.2%在活检后>45 天开始治疗。前往主要城市就医、行政因素和对乳腺癌的误解等因素阻碍了乳腺癌的及时、持续治疗。多学科和文化定制的患者教育有助于理解疾病，并迅速决定后续的医疗护理。
需要加强首都以外地区的乳腺癌治疗能力、标准化转诊途径、确保旅行费用的财政支持，并加强患者教育，以确保与乳腺癌护理连续体的联系。需要强大的信息系统来跟踪患者并评估该计划的绩效。
