Time to follow-up of an abnormal mammogram in women with diabetes: a population-based study

Women with diabetes have a higher breast cancer incidence and mortality. They are also significantly less likely to undergo screening mammography and present with more advanced stage than women without diabetes. The purpose of this study was to examine if women with diabetes are more likely to have delays in follow-up of abnormal mammograms, compared to women without diabetes. Using population-based health databases, this retrospective cohort study examined women between the ages of 50 and 74, with and without diabetes, living in the province of Ontario, Canada, who underwent screening through a centralized program and who had an abnormal mammogram between 2003 and 2012. We compared rates of follow-up of a diagnostic test within 180 days, as well as likelihood of mastectomy or excision procedure and a diagnosis of breast cancer. Following an abnormal screening mammogram, 97.5% of women with diabetes had a diagnostic procedure within 180 days compared to 97.9% of women without diabetes. After adjustment for other factors, women with diabetes were only 3% less likely to have follow-up testing after an abnormal mammogram than women without diabetes (hazard ratio [HR] 0.97, 95% CI: 0.96-0.99, P < 0.001). The majority of Ontario women who underwent screening mammography through a centralized screening program had timely follow-up of an abnormal mammogram, with no meaningful delays in those who had diabetes. The results of this study suggest that diagnostic delays after screening do not significantly contribute to higher breast cancer mortality in women with diabetes.