Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
J Gen Intern Med. 2023 Jan;38(1):21-29. doi: 10.1007/s11606-022-07657-4. Epub 2022 May 31.
Inequitable follow-up of abnormal cancer screening tests may contribute to racial/ethnic disparities in colon and breast cancer outcomes. However, few multi-site studies have examined follow-up of abnormal cancer screening tests and it is unknown if racial/ethnic disparities exist.
This report describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems.
We conducted a retrospective cohort study using data from five California public hospital systems. We used multivariable robust Poisson regression analyses to examine whether patient-level factors or site predicted receipt of follow-up test.
Using data from five public hospital systems between July 2015 and June 2017, we assessed follow-up of two screening results: (1) colonoscopy after positive fecal immunochemical tests (FIT) and (2) tissue biopsy within 21 days after a BIRADS 4/5 mammogram.
Of 4132 abnormal FITs, 1736 (42%) received a follow-up colonoscopy. Older age, Medicaid insurance, lack of insurance, English language, and site were negatively associated with follow-up colonoscopy, while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 1082 (64%) received a timely biopsy; only site was associated with timely follow-up biopsy.
Despite the vulnerabilities of public-hospital-system patients, follow-up of abnormal cancer screening tests occurs at rates similar to that of patients in other healthcare settings, with colon cancer screening test follow-up occurring at lower rates than follow-up of breast cancer screening tests. Site-level factors have larger, more consistent impact on follow-up rates than patient sociodemographic traits. Resources are needed to identify health system-level factors, such as test follow-up processes or data infrastructure, that improve abnormal cancer screening test follow-up so that effective health system-level interventions can be evaluated and disseminated.
癌症筛查检测异常结果的后续处理不公平，可能导致结直肠癌和乳腺癌结局的种族/民族差异。然而，很少有多地点研究检查过癌症筛查检测异常的后续处理情况，也不知道是否存在种族/民族差异。
本报告描述了结直肠癌和乳腺癌筛查检测异常后续处理的模式，并探讨了在公立医院系统中是否存在种族/民族差异。
我们使用来自五个加利福尼亚州公立医院系统的数据开展了一项回顾性队列研究。我们使用多变量稳健泊松回归分析来检查患者层面的因素或地点是否预测是否接受后续检测。
我们使用五个公立医院系统在 2015 年 7 月至 2017 年 6 月之间的数据，评估了两种筛查结果的后续处理情况：（1）阳性粪便免疫化学检测（FIT）后的结肠镜检查，以及（2）BI-RADS 4/5 乳腺 X 线摄影后 21 天内进行组织活检。
在 4132 例异常 FIT 中，有 1736 例（42%）接受了结肠镜检查。年龄较大、医疗补助保险、无保险、英语语言和地点与接受结肠镜检查呈负相关，而西班牙裔和亚裔与接受结肠镜检查呈正相关。在 1702 例 BI-RADS 4/5 乳腺 X 线摄影中，有 1082 例（64%）及时进行了活检；只有地点与及时进行活检相关。
尽管公立医院系统患者存在脆弱性，但癌症筛查检测异常的后续处理率与其他医疗保健环境中的患者相似，结直肠癌筛查检测的后续处理率低于乳腺癌筛查检测。地点层面的因素对后续处理率的影响更大、更一致，而患者社会人口统计学特征的影响则较小。需要资源来确定改善癌症筛查检测异常后续处理的卫生系统层面的因素，如检测后续处理流程或数据基础设施，以便可以评估和推广有效的卫生系统层面干预措施。
