Time to diagnostic resolution after an uncertain screening mammogram in an underserved population

Area of Science:

• Radiology
• Oncology
• Health Services Research

Background:

• Screening mammography reduces breast cancer mortality.
• Uncertain mammograms (BI-RADS 0) require further diagnostic evaluation.
• Limited data exists on diagnostic resolution factors for Chinese patients in the US.

Purpose of the Study:

• To identify patterns of diagnostic resolution after uncertain screening mammograms.
• To evaluate the impact of primary care provider (PCP) location on diagnostic resolution time in Chinese patients.
• To compare diagnostic resolution time between Chinese patients with and without an integrated PCP.

Main Methods:

• Retrospective analysis of 368 patients with BI-RADS 0 mammograms from 2015-2016.
• Evaluation of diagnostic resolution time and associated factors.
• Multivariable regression analysis adjusting for demographic and clinical factors.

Main Results:

• 93% of patients achieved diagnostic resolution, with a median time of 27 days.
• Chinese origin, non-integrated PCP, and subsidized insurance were associated with longer resolution times.
• Chinese patients with an integrated PCP had timelier diagnostic resolution (HR=1.85, P=.02).

Conclusions:

• Integrated primary care within an institution is associated with timelier diagnostic resolution for Chinese patients.
• Chinese patients without integrated primary care are at risk for delayed diagnosis after uncertain screening mammograms.
• Interventions should target at-risk patients to ensure follow-up and prevent loss to care.