DELAY TO BIOPSY AFTER A POSITIVE MAMMOGRAM. R.G. Pinckney 1 , B.M. Geller 2 , M. Coahran 2 , P. Vacek 2 , B. Littenberg 1 ; 1 University of Vermont, Burlington, VT PURPOSE: Delay from detection to diagnosis has been associated with more advanced stage at diagnosis and decreased survival in women with breast cancer. We sought to determine the delay to biopsy after mammographic detection of suspicious lesions at a statewide level. METHODS: The Vermont Mammography Registry (VMR) collects information on all mammograms and breast pathology obtained in Vermont. Mammograms performed on Vermont women between 1/1/1994 and 8/31/1999 with Breast Imaging Reporting and Data System (BI-RADS) category 4 assessments (suspicious for malignancy) or category 5 assessments (highly suggestive of malignancy) were considered positive and in need of biopsy. These mammograms were matched to a subsequent biopsy obtained by fine needle aspirate, core biopsy, or surgery. We calculated the proportion of patients who had biopsies performed within 30 days, had biopsies within 1 to 12 months, and not biopsied within 12 months after the positive mammogram. RESULTS: 5,713 mammograms met eligibility criteria. 57.8% of mammograms were followed by biopsy within 1 month, 18.5% within 1 month to 12 months, and 23.8% did not have a biopsy within one year. There was a significant variation (p < .001) in time to biopsy by facility with a range of 33.5% to 77.5% of patients biopsied within one month and 9.3% to 60.0% not having had a biopsy within one year CONCLUSION: Though a majority of women received an expedient biopsy after a positive mammogram, the large proportion of women having a delayed biopsy or apparent lack of biopsy is of concern. The short-term follow-up of marginally abnormal mammograms presents a challenge to both physicians and patients. A variety of systems and individual factors may impact on the adherence to mammographers' recommendations. We sought to assess the extent of this problem and to examine the factors associated with the provision of appropriate follow-up care. METHODS: Among a sample of 579 women with abnormal screening mammograms or breast complaints, we analyzed the clinical data of 126 women who had marginally abnormal mammograms for which the mammographers recommended 6-month repeat follow-up mammograms. All women were contacted for detailed telephone surveys at the time of their index mammogram, and 7 to 8 months later. The medical records of these women were reviewed to determine the breast care they received before and during the follow-up period. Women who received follow-up mammograms as recommended, saw breast specialists, or underwent breast biopsies within the 7 ± 8 month follow-up period were considered to have received appropriate follow-up care. We then studied the differences between women who did and did not receive appropriate follow-up care April 1, 1996 and March 31, 1997 . Each discharge record contains up to 16 diagnoses, 16 corresponding diagnosis type indicators (value of`2' = complication), and up to 10 procedures. A clinically trained chart reviewer examined the corresponding medical charts for evidence of diagnoses and complications. A complication was defined as a new diagnosis arising after the start of hospitalization. We defined 12 common conditions using the ICD-9-CM coding system: stroke, cystitis/pyelonephritis, atrial fibrillation, respiratory failure, post-hemorrhage anemia, pneumonia, bowel obstruction, congestive heart failure, acute renal failure, myocardial infarction, atelectasis, and pleural effusion. We then selected records with presence of a condition in both administrative data and chart review data. Finally, we determined the extent to which the diagnosis type indicator in administrative data agreed with the chart reviewer's assessment (criterion standard) of whether a diagnosis was a complication or not.