Abstract C64: Inadequate follow-up of abnormal mammography screening results in Hispanic/Latinas living in the northeast US
Authors: Jones Beth A. , Parra Steven , Genao Inginia , Nunez-Smith Marcella , Claus Elizabeth , Soler-Vila Hosanna , Calvocoressi Lisa , Markowski Justin 
Published: February 2019

Background: Breast cancer is the most common cause of cancer death among Hispanic/Latino patients. Similar to non-Hispanic Black women, Hispanic/Latino women are more likely to be diagnosed with later-stage breast cancer and experience worse survival rates when compared to non-Hispanic White women. From a larger prospective study of cancer screening in Hispanic/Latinas living in the northeast US, the purpose of this investigation was to identify predictors of inadequate follow-up of abnormal screening mammograms in this culturally diverse Hispanic/Latino population.

Methods: We studied 189 subjects with abnormal or inconclusive screening mammogram results identified from a prospective cohort of 1570 Hispanic/Latino (H/L) women) enrolled 2009-2012, aged 40-75, and living in major H/L enclaves in Connecticut. Based on a review of radiology records, we studied their cancer screening experience over a 2- to 4-year period. For women who required immediate follow-up (BI-RADS categories 0,4,5), follow-up was considered adequate if the recommended diagnostic procedure was completed within three months of the screening mammogram. Subjects who received recommendations for short-term follow-up (BI-RADS 3) were classified as receiving adequate follow-up if the recommended tests were completed within nine months of the index screening exam. A wide range of potential predictors including socioeconomic status, acculturation, medical care, knowledge, and attitudes based on the Health Belief Model were evaluated. Using multivariate logistic regression, we identified independent predictors of inadequate follow-up of an abnormal mammogram.

Results: Over 30% of women requiring immediate or short-term follow-up did not receive this care within three months of the recommended return date. Adjusting for socioeconomic status, marital status, factors associated with acculturation, continuity of care, insurance status, and prior screening, patient body mass index (normal/overweight vs obese), age (&lt;50 vs 50+), pain experienced during the screening mammogram (a lot/fair amount vs none/little), and a subject's perceived control over health outcomes (more vs less control) were significant independent predictors of inadequate follow-up. Poor self-rated health also emerged as a significant predictor of inadequate follow-up, but its effect was primarily observed in women who had 2 or more comorbid conditions (diabetes, high blood pressure, heart disease, or high cholesterol); p value for interaction was .058.

Conclusion: While inadequate follow-up of abnormal exams undermines the potential benefit of mammography screening for all women, these findings may have implications for the poorer breast cancer outcomes observed in Hispanic/Latinas. Given that these at-risk, under-resourced women followed their providers' recommendation to obtain a screening mammogram, these results are a reminder that many women, particularly those who are younger, find mammograms to be painful, or have poor self-rated health are at risk for not receiving adequate follow-up following this exam. As the wording of screening recommendations shifts to a greater emphasis on shared decision making, providers should use this opportunity to reinforce the importance of follow-up in receiving the full benefit of screening mammography.

Citation Format: Beth A. Jones, Steven Parra, Inginia Genao, Marcella Nunez-Smith, Elizabeth Claus, Hosanna Soler-Vila, Lisa Calvocoressi, Justin Markowski. Inadequate follow-up of abnormal mammography screening results in Hispanic/Latinas living in the northeast US [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C64.