Abstract B82: Time to clinical follow up after abnormal mammogram in African American and Hispanic women: Preliminary findings.
Authors: Petersen Shariska S. , Sarkissyan Marianna , Wu Yanyuan , Carlota Marianne , Vadgama Jaydutt V. 
Published: August 2014

Background: Increased time to clinical follow-up after abnormal mammogram may be a significant factor which contributes to health disparities in breast cancer. Women from disadvantaged socioeconomic backgrounds, such as African-American and Hispanic women, have poor access to healthcare which may result in an increase in the time-to-followup after abnormal mammogram. The objective of this study was to evaluate the time-to-followup in a cross-sectional cohort of African-American and Hispanic women who obtained screening or cancer care in MLK-MACC county hospital in South Los Angeles.

Methods: This study reports preliminary data from a cross-sectional study of 75 women (n = 30 African-American and n = 45 Hispanic). Patient histories were constructed for women who received an incomplete or abnormal mammogram (BI-RAD score other than BI-RAD = 1 or 2) and were clinically evaluated further to be diagnosed with either breast cancer, benign breast disease, or with no breast disease. Time-to-followup was assessed in days after abnormal mammogram to subsequent clinical breast-related care received. Clinical, personal, and socioeconomic variables were obtained by medical chart abstraction and survey. Data were analyzed using SPSS software.

Results: The median number of days until clinical followup after abnormal mammogram for the women in the study was N = 30 days (Range: 0 – 357 days). All women with BIRAD = 4 (Moderately Suspicious for Malignancy) and 5 (Highly Suspicious for Malignancy) received biopsies as the next clinical evaluation after abnormal mammogram in compliance with recommended guidelines. Among women with BIRAD Score = 0 (Incomplete): 21% received radiological followup with no further need to evaluate for abnormality, 29% received surgical followup (either biopsy or FNA), and 50% received biopsy only after a delay of requiring additional radiological evaluation. There was a statistically significant difference in the time-to-biopsy among women who were scored BIRAD 0 and women who were immediately scored BIRAD 4 or 5 (P=0.01, 108 median days BIRAD 0 vs. 40 median days for BIRAD 4/5). Among women with BIRAD = 0 who obtained surgical evaluation after radiological evaluation, 57% were diagnosed with breast cancer. There was no statistically significant association between ethnicity, socioeconomic factors, and days to 1st follow-up (P&gt;0.05). This study also reports that 38% of women had lower breast density (BIRAD = D1 or D2) and 62% had higher breast density (BIRAD = D3 or D4). All women with higher breast density (BIRAD 4- Extremely Dense, N = 4) had Incomplete BI-RAD Score (BIRAD = 0 - Incomplete, Needs Further Followup).

Conclusions: In sum, these data indicate that our medical center services provide clinical followup in compliance with recommended guidelines. However, women with BIRAD = 0 may be at a higher risk of experiencing delays in diagnosis and treatment due to increased amount of time necessary to evaluate and refer for diagnostic biopsy. Higher breast density may contribute to women receiving BIRAD = 0; and African-American and Hispanic women have high breast density (D3 and D4). Thus, increased breast density in this cohort of women may contribute to an increased likelihood of obtaining inconclusive mammograms and lead to delays in diagnosis and care. Future studies will expand the number of the present cohort and include analysis on additional variables correlated with time-to-followup.

Acknowledgements: Thank you to all the women who participated in this study. These activities were supported in part by grants from NIH/National Cancer Institute 1U54CA14393-01; U56 CA101599-01; CA15083-25S3; R25DK067015-01; to J.V. Vadgama.

Citation Format: Shariska S. Petersen, Marianna Sarkissyan, Yanyuan Wu, Marianne Carlota, Jaydutt V. Vadgama. Time to clinical follow up after abnormal mammogram in African American and Hispanic women: Preliminary findings. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B82.