Yue Lu, Ren Wenhui, Zhang Le, Wu Feihong, Chen Jinping, Wang Yang, Xiao Yuan, Zhu Guiqing, Lan Haiyan, Wu Jianqing, Li Huibin, Zhao Xuelian, Qiao Youlin, Zhao Fanghui, Zhang Yong
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BMC Public Health. 2025 May 13;25(1):1752. doi: 10.1186/s12889-025-22879-x.
Timely diagnostic follow-up subsequent to abnormal results is crucial for the efficacy of breast cancer screening programs. We aimed to identify the frequency and women-level factors of loss or delay in the follow-up for screening abnormalities in China.
This mixed-methods cohort study comprised a retrospective analysis of ultrasound based breast screening data collected from Boluo (site A), Lilin (site B), and Ordos (site C) in China from 2018 to 2021, and qualitative, semistructured interviews conducted with program leaders from the three local Maternal and Child Health (MCH) hospitals, respectively. According to the screening protocol, we assessed the follow-up of two screening results: (1) mammography after suspicious results in the ultrasound and (2) biopsy after positive results in the ultrasound or supplement mammography. The rates and timeliness of follow-up with diagnostic examinations were compared across the different sites and procedures, and logistic regression was employed to explore the women-level factors influencing failure or delay in follow-up.
Of 7,939 women with abnormal screening results, 5,943 (74.86%) received final diagnostic tests, while 4,631 (58.33%) got final diagnosis timely. The follow-up rate for mammography was higher than that for biopsy. Site A performed better in follow-up, with an overall follow-up rate of 98.01%, which may be related to the provision of free biopsy services and the establishment of a robust referral system. Women aged 45 to 54 years (ref: 35-44 years; aOR = 1.18; 95% CI: 1.01, 1.38; P = 0.032) were more likely to be lost to follow-up. Women who had never attended breast screening (ref: ever screened; aOR = 1.15; 95% CI: 1.00, 1.32; P = 0.046) were at high risk for delayed follow-up. Conversely, women with a high level of education (aOR = 0.66; 95% CI: 0.59, 0.73; P < 0.001) and those with abnormal clinical breast examination results (ref: with normal results; aOR = 0.79; 95% CI: 0.69, 0.92; P = 0.002) were more likely to get timely follow-up.
The overall follow-up rate and quality among women with abnormal screening results showed significant regional variability, and still required to be improved. Moreover, women with higher age and lower educational levels were particularly at high risk for delayed follow-up care and deserved more attention.
异常结果后的及时诊断随访对于乳腺癌筛查项目的效果至关重要。我们旨在确定中国筛查异常随访中失访或延迟的频率及女性层面的因素。
这项混合方法队列研究包括对2018年至2021年在中国博罗（A地）、荔林（B地）和鄂尔多斯（C地）收集的基于超声的乳腺筛查数据进行回顾性分析，以及分别对三家当地妇幼保健（MCH）医院的项目负责人进行定性、半结构化访谈。根据筛查方案，我们评估了两种筛查结果的随访情况：（1）超声检查结果可疑后的乳腺钼靶检查，以及（2）超声检查或补充乳腺钼靶检查结果阳性后的活检。比较了不同地点和程序的诊断检查随访率及及时性，并采用逻辑回归探索影响随访失败或延迟的女性层面因素。
在7939名筛查结果异常的女性中，5943名（74.86%）接受了最终诊断检查，而4631名（58.33%）及时得到了最终诊断。乳腺钼靶检查的随访率高于活检。A地在随访方面表现较好，总体随访率为98.01%，这可能与提供免费活检服务和建立完善的转诊系统有关。45至54岁的女性（对照：35至44岁；调整后比值比[aOR]=1.18；95%置信区间[CI]：1.01，1.38；P=0.032）更有可能失访。从未参加过乳腺筛查的女性（对照：曾接受筛查；aOR=1.15；95%CI：1.00，1.32；P=0.046）延迟随访的风险较高。相反，受教育程度高的女性（aOR=0.66；95%CI：0.59，0.73；P<0.001）和临床乳腺检查结果异常的女性（对照：结果正常；aOR=0.79；95%CI：0.69，0.92；P=0.002）更有可能及时得到随访。
筛查结果异常女性的总体随访率和质量存在显著的地区差异，仍需改进。此外，年龄较大和教育程度较低的女性延迟随访护理的风险尤其高，值得更多关注。
