title: Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women.
abstract: BACKGROUND
  Delayed or incomplete follow-up after abnormal screening results may compromise the effectiveness of breast cancer screening programs, particularly in medically underserved and minority populations. This study examined the role of socioeconomic status, breast cancer risk factors, health care system barriers, and patient cognitive-attitudinal factors in the timing of diagnostic resolution after abnormal breast cancer screening exams among Black women receiving breast cancer screening at three New York city clinics.
  
  
  METHODS
  We identified 184 Black women as having an abnormal mammogram or clinical breast exam requiring immediate follow-up and they were interviewed and their medical records examined. Bivariate and multivariate logistic regression analyses were used to assess the association between patient and health care system factors and diagnostic resolution within 3 months of the abnormal finding.
  
  
  RESULTS
  Within 3 months, 39% of women were without diagnostic resolution and 28% within 6 months. Neither socioeconomic status nor system barriers were associated with timely diagnostic resolution. Timely resolution was associated with mammogram severity, patients asking questions (OR, 2.73; 95% CI, 1.25-5.96), or receiving next step information (OR, 2.6; 95% CI, 1.08-6.21) at the initial mammogram. Women with prior breast abnormalities were less likely to complete timely diagnostic resolution (OR, 0.42; 95% CI, 0.20-0.85), as were women with higher levels of cancer anxiety (OR, 0.50; 95% CI, 0.27-0.92).
  
  
  CONCLUSIONS
  Interventions that address a woman's prior experience with abnormal findings and improve patient/provider communication may improve timely and appropriate follow-up.
authors.affiliation: Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, MD 20892-0001, USA. kernerj@mail.nih.gov
authors.forename: Jon F
authors.initials: JF
authors.lastname: Kerner
authors.forename: Michael
authors.initials: M
authors.lastname: Yedidia
authors.forename: Deborah
authors.initials: D
authors.lastname: Padgett
authors.forename: Barbara
authors.initials: B
authors.lastname: Muth
authors.forename: Kathleen Shakira
authors.initials: KS
authors.lastname: Washington
authors.forename: Mariella
authors.initials: M
authors.lastname: Tefft
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
authors.forename: Erini
authors.initials: E
authors.lastname: Makariou
authors.forename: Harold
authors.initials: H
authors.lastname: Freeman
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
mesh_terms: D000328:Adult; D044383:Black People; D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City; D012307:Risk Factors; D012959:Socioeconomic Factors; D001741:Black or African American