The Effect of Previous Experiences with Cancer on Timely Diagnostic Follow-up after Abnormal Mammogram Among Women Accessing Care in Medically Underserved Areas

Background/Purpose

Breast cancer is the second most lethal cancer for women with an estimated 40,000 women dying from the disease in 2014. Studies have documented that women from medically underserved areas and racial and ethnic minority populations experience an undue burden of cancer that has been attributed in part to delays in timely diagnostic follow-up of abnormal mammogram. A myriad of factors affect timely diagnostic follow-up. One factor is risk perception, which is a component of most current models of health promotion and health-protective behaviors. Studies have documented that women with a family history of cancer perceive their risk of developing the disease as high. Yet, few empirical studies have focused on the relationship between previous experiences with cancer and timely diagnostic follow-up of abnormal mammogram. The purpose of this study is to explore how previous experience or lack of experience with cancer impact women’s timely diagnostic follow-up after abnormal mammogram.

Methods

Data/Sample: We examined data collected between June 2011 and June 2014 as part of the Patient Navigation in Medically Underserved Areas study, a randomized controlled trial conducted to explore the effect of navigation on breast health outcomes in Chicago. Our sample included a total of 569 randomized patients with abnormal mammograms requiring further diagnostic follow-up.

Measures: Time to diagnostic resolution was measured as a continuous variable-the number of days between an abnormal screening mammogram or diagnostic mammogram and confirmation of a definitive diagnosis, either benign or malignant, in the patient electronic medical record. Survey questionnaire items including having a history of abnormal mammogram, personal history of cancer, family history of cancer, family history of breast cancer, and history of being a caregiver to a family member or friend with cancer were dichotomized (yes/no).

Results

Our findings indicated there was not a statistically significant relationship between time to diagnostic resolution after abnormal mammogram and women with previous abnormal mammogram findings, being a cancer survivor, or having a family history of cancer. However, women with a family history of breast cancer (HR = 2.58, 95% CI, 1.36-4.89) and women who had been a caregiver to a family member or friend with cancer (HR = 2.25, 95% CI, 1.35-3.77) had shorter time to diagnostic resolution.

Conclusions/Implications

We conclude previous experiences with cancer may impact women’s timely diagnostic follow-up after abnormal mammogram. These findings highlight the importance of gathering and documenting women’s cancer experiences, both medical and psychosocial, as a strategy for timely diagnostic follow-up. Furthermore, women with no family history of breast cancer or cancer caregiving experience may not be aware of the importance of timely follow-up. Patient-provider interactions about the importance of timely follow-up may be particularly important for women without cancer experiences accessing care in medically underserved areas. Identifying women who are likely or unlikely to follow-up is important in the development and implementation of future interventions to increase timely follow-up after abnormal mammogram.