Desai Aditi, Rodriguez de la Vega Pura, Castro Grettel, Bhoite Prasad, Bisschops Julia, Varella Marcia
Department of Medical Education, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Department of Humanities, Health, and Society, Florida International University, Herbert Wertheim College of Medicine, Miami, USA.
Cureus. 2024 Sep 11;16(9):e69213. doi: 10.7759/cureus.69213. eCollection 2024 Sep.
Background The Linda Fenner 3D Mobile Mammography Center (LFMMC) was created to reduce disparities in screening for breast cancer and improve survival for women with limited access to such screening. However, for screened patients requiring follow-up testing, research has shown a wide variation of time taken to access diagnostic imaging, especially among uninsured women. Aim To explore factors associated with longer (>30 days) time intervals to complete diagnostic imaging after screening. Methods This was a retrospective cohort study using data from the LFMMC from 2014 to 2022. Women living in Miami-Dade County (MDC), over the age of 40, uninsured, and requiring follow-up diagnostic imaging after breast cancer screening were included. Factors assessed included women's age, area of residency, race, primary language spoken, marital status, body mass index (BMI), history of hormone use, previous mammogram, breast implants, breast cancer in immediate family, past breast surgery, and menopause status. The interval of time taken between receiving a screening mammogram result and completing further diagnostic imaging was the outcome, dichotomized into greater than 30 days (longer follow-up time) or up to 30 days. Multivariable binary logistic regression models were used to estimate independent associations (odds ratio [OR] and 95% confidence interval [CI]) of selected factors and longer time intervals to complete diagnostic imaging follow-up. Results We analyzed data from 926 eligible patients. The mean age was 50.1 years (SD = 8.81). A majority were white (n = 643; 69%), Hispanic (n = 698; 72%), had a history of previous mammograms (n = 589; 64%), and had no family history of breast cancer (n = 757; 82%). About 50% had a diagnostic follow-up exam performed after 30 days (median time to follow-up was 32, interquartile range 23-46 days). Single women had 30% lower odds of longer follow-up than married women (OR 0.70, 95% CI 0.52-0.93). Residents of Homestead (a city within Miami-Dade County) had 2.5 higher odds of having a longer time to follow-up, compared to non-Homestead residents (OR 2.50, 95% CI 1.60-3.90). Conclusions Being single was associated with a shorter time to follow up with diagnostic imaging while residing in Homestead was associated with a longer time to follow-up. Further research with a larger sample and further details on patient characteristics are warranted to better identify targets for interventions aimed at optimizing continuity of care and detecting breast cancer at earlier stages.
琳达·芬纳3D移动乳腺摄影中心（LFMMC）的设立旨在减少乳腺癌筛查方面的差异，并提高那些难以获得此类筛查的女性的生存率。然而，对于需要后续检测的筛查患者，研究表明进行诊断性成像所需的时间差异很大，尤其是在未参保女性中。目的：探讨与筛查后完成诊断性成像的较长时间间隔（>30天）相关的因素。方法：这是一项回顾性队列研究，使用了LFMMC 2014年至2022年的数据。纳入居住在迈阿密-戴德县（MDC）、年龄超过40岁、未参保且乳腺癌筛查后需要后续诊断性成像的女性。评估的因素包括女性的年龄、居住地区、种族、主要语言、婚姻状况、体重指数（BMI）、激素使用史、既往乳房X光检查、乳房植入物、直系亲属中的乳腺癌、过去的乳房手术以及绝经状态。从收到筛查乳房X光检查结果到完成进一步诊断性成像的时间间隔作为结果，分为大于30天（较长的随访时间）或至多30天。多变量二元逻辑回归模型用于估计选定因素与完成诊断性成像随访的较长时间间隔之间的独立关联（比值比[OR]和95%置信区间[CI]）。结果：我们分析了926名符合条件患者的数据。平均年龄为50.1岁（标准差=8.81）。大多数为白人（n = 643；69%）、西班牙裔（n = 698；72%），有既往乳房X光检查史（n = 589；64%），且无乳腺癌家族史（n = 757；82%）。约50%的患者在30天后进行了诊断性随访检查（随访的中位时间为32天，四分位间距为23 - 46天）。单身女性随访时间较长的几率比已婚女性低30%（OR 0.70，95% CI 0.52 - 0.93）。与非霍姆斯特德居民相比，霍姆斯特德（迈阿密-戴德县内的一个城市）的居民随访时间较长的几率高出2.5倍（OR 2.50，95% CI 1.60 - 3.90）。结论：单身与诊断性成像随访时间较短相关，而居住在霍姆斯特德与随访时间较长相关。有必要进行更大样本的进一步研究以及关于患者特征的更多细节，以更好地确定旨在优化连续护理并在早期阶段检测乳腺癌的干预目标。
