Completeness and Timeliness of Diagnostic Follow-up for Mammograms in Palau, 2019-2024

In the Republic of Palau, breast cancer screening rates are low, and many women needing diagnostic follow-up after a mammogram do not receive it. This descriptive retrospective study evaluated the completeness and timeliness of follow-up for screening mammograms requiring follow-up among women aged 40-74 years in Palau's Breast and Cervical Cancer Early Detection Program (BCCEDP) from July 2019 to June 2024. The databases used in this study were the Cancer Screening and Tracking System (CaST) and the Case Manager workbook. Descriptive statistics were used to determine the proportion of mammogram results requiring follow-up by age group and program year, the proportion of those requiring follow-up that received it by age group, program year; and Breast Imaging-Reporting and Data Systems (BI-RADS) categories; and the duration of follow-up among those who received follow-up by BI-RADS categories. Chi-square tests were used to determine statistical significance. Findings show that 17.1% of mammogram results requiring follow-up had no completed follow-up over the 5 years, with the proportion increasing over time, reaching 30.9% in the 2023-2024 program year (P<.001). This was highest among those in BI-RADS 5 (highly suggestive of malignancy) at 38.5% (P<.006). Additionally, only 51.5% of mammogram results requiring follow-up achieved resolution within the program's target of ≤60 days. These delays and incomplete follow-ups reveal major gaps in patient tracking, communication, and care coordination within the screening continuum. Strengthening routine monitoring of follow-up indicators is recommended to support continuous quality improvement.