Abstract B75: Factors correlated with follow up after an abnormal mammogram: A population-based study
Authors: Lightbourne Taber C. , Chagpar Anees B. 
Published: October 2015

Introduction: There are a plethora of data regarding factors correlating with screening mammography, yet a relative paucity of data regarding factors correlated with following the recommendation for further testing after an abnormal mammogram. We hypothesized that socioeconomic status, race/ethnicity and insurance would be key drivers in patients' decision to follow the recommendation for further tests.

Methods: The National Health Interview Survey is a face-to-face population-based study conducted annually by the CDC, and is the largest source of health information for Americans. Data from the 2010 Cancer Supplement, which included questions regarding follow-up after abnormal mammograms, were used for this analysis. Univariate and multivariate analyses were conducted using SAS-Callable SUDAAN software.

Results: In 2010, there were 8518 women over the age of 30 who answered the question regarding the recommendation for further testing after their most recent mammogram, representing 65,226,785 women in the population. Of these, 10.6% were recommended to have further tests done. Women under the age of 65 were significantly more likely to be recommended to have further imaging than their older counterparts (p=0.0005). Recommendation for further testing did not vary by region (p=0.599), race/ethnicity (p=0.126), income (p=0.124), and education (p=0.771). Insurance status was also associated with recommendation for further testing on univariate analysis. On multivariate analysis, however, neither age nor insurance were predictive of recommendations for further testing. Of the 881 people (6,912,415 in the population) for whom additional testing was recommended, 82.4% followed this guidance. Factors correlating with following these recommendations included insurance status (p=0.008), education (p=0.010), and income (p&lt;0.001). Age, region and race/ethnicity were not correlated with the decision to comply with follow-up recommendations. On multivariate analysis, controlling for education and income, insurance status remained the only predictor of the likelihood of a patient to follow recommendations for further testing after an abnormal mammogram (p=0.0128). Compared to the uninsured population, those with private insurance were 2.7 times more likely to follow recommendations for further testing (95% CI: 1.37-5.44, p=0.005).

Conclusion: Nearly 11% of women undergoing mammography will be recommended to have further testing; however, nearly 20% will not follow these recommendations. Lack of insurance status was the only factor correlating with a significantly lower likelihood to comply with recommended further testing; race/ethnicity, income and education were not independent predictors on multivariate analysis. This finding highlights the importance of insurance as a means to secure access for early breast cancer detection.

Citation Format: Taber C. Lightbourne, Anees B. Chagpar. Factors correlated with follow up after an abnormal mammogram: A population-based study. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B75.