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The American Journal of Managed Care February 2011
Effect of Multiple Chronic Conditions Among Working-Age Adults
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Timing of Follow-up After Abnormal Screening and Diagnostic Mammograms
Karen J. Wernli, PhD; Erin J. Aiello Bowles, MPH; Sebastien Haneuse, PhD; Joanne G. Elmore, MD, MPH; and Diana S.M. Buist, PhD, MPH
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Timing of Follow-up After Abnormal Screening and Diagnostic Mammograms

Karen J. Wernli, PhD; Erin J. Aiello Bowles, MPH; Sebastien Haneuse, PhD; Joanne G. Elmore, MD, MPH; and Diana S.M. Buist, PhD, MPH
Woman-level characteristics such as breast symptoms at mammography are associated with earlier follow-up within an integrated health system with an active breast health plan.
In our study, fewer than 1% and 4% of women with abnormal screening and diagnostic mammograms, respectively, did not receive any follow-up within 180 days (data not shown). Other studies have reported lack of follow-up in women after abnormal exams at rates between 8% and 28%.5,10 The difference in rates of follow-up is likely due to the ability of women to receive additional medical services within our health system at no financial burden and with the assistance of specially trained nurses working in the breast program. The use of computer monitoring to follow up with women postmammography reduces the delays in seeking care.22,23 Group Health’s Breast Cancer Screening Program implemented active follow-up of women with breast clinic nurses and now uses the electronic medical record to help track women.

This study was conducted in a well-characterized defined population of women who receive healthcare through an integrated delivery system. There was thorough assessment and follow-up of mammography screening because of the Breast Cancer Screening Program at Group Health. We might have missed some clinical care that occurred at outside facilities that was not submitted for a claim. However, this is unlikely for women with their primary insurance at the health plan, because filing a claim would enable payment for outside services and women would be motivated to do so.

Clinical guidelines for promptness in obtaining an evaluation after an abnormality is noted on mammography examination are not well established. An assessment of the National Initiative on Cancer Care Quality in the United States suggests that 90% of patients should be seen within 3 weeks of an abnormal screening mammogram for a diagnostic mammogram, within 14 days from needing an open biopsy to cancer diagnosis, and within 5 working days from breast cancer diagnosis to an appointment with the treating physician.24 While we cannot make a direct comparison to the National Initiative for Cancer Care Quality, we can report that 82% of women received the recommended follow-up care within 3 weeks of their abnormal screening mammogram. Further, 69% of women with abnormal diagnostic mammograms received recommended follow-up care within 7 days. In 2004, the National Quality Measures for Breast Centers identified 2 measures of timely follow-up: imaging timeliness of care (ie, time between screening mammogram, diagnostic mammogram, needle biopsy, surgery) and surgical timeliness (ie, time between diagnostic mammogram, open surgical biopsy/excision, initial breast cancer surgery).25 There are characteristics that influence women’s timeliness to follow-up that future interventions may address to reduce delays in breast cancer diagnosis.

Author Affiliations: From Group Health Research Institute (KJW, EJAB, SH, DSMB), Seattle, WA; and Department of General Internal Medicine (JGE), University of Washington, Seattle, WA.


Funding Source: This research was supported by the National Cancer Institute (Dr Buist, Principal Investigator, U01CA63731; and Dr Elmore, Principal Investigator, K05CA104699).


Author Disclosures: The authors (KJW, EJAB, SH, JGE, DSMB) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.


Authorship Information: Concept and design (EJAB, DSMB); acquisition of data (DSMB); analysis and interpretation of data (KJW, EJAB, SH, JGE, DSMB); drafting of the manuscript (KJW, JGE, DSMB); critical revision of the manuscript for important intellectual content (KJW, EJAB, SH, JGE, DSMB); statistical analysis (KJW, SH, DSMB); provision of study materials or patients (DSMB); obtaining funding (DSMB); administrative, technical, or logistic support (DSMB); and supervision (DSMB).


Address correspondence to: Karen J. Wernli, PhD, Group Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101. E-mail:

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