title: Factors affecting follow-up among low-income women with breast abnormalities.
abstract: OBJECTIVE
  To assess factors affecting follow-up care among low-income women after identification of a breast abnormality.
  
  
  METHODS
  Women with a newly discovered breast abnormality were selected from one public hospital and two comprehensive health centers (CHCs) in Los Angeles county. Twelve months later, a telephone survey and medical chart review were conducted.
  
  
  RESULTS
  Of the 535 respondents, 8.6% received no follow-up care. Among those with follow-up care, 29.4% received inadequate care (did not initiate follow-up in a timely manner or did not complete all recommended procedures). Factors affecting receipt of any follow-up care included having the index visit at a CHC vs. a hospital (OR 2.79, CI 1.20-6.50), patient uncertainty about where to receive care (OR 0.24, CI 0.07-0.77), and recommendation of a clinical breast examination (CBE) (OR 0.12, CI 0.04-0.40) or 6-month mammogram (OR 0.11, CI 0.04-0.31) vs. a diagnostic mammogram as a first follow-up procedure. Factors affecting receipt of adequate follow-up care included index visit at a CHC vs. a hospital (OR 1.90, CI 1.13-3.20), being white/Asian Pacific Islander/other vs. Latina (OR 5.33, CI 1.71-16.68), recommendation of a 6-month mammogram vs. a diagnostic mammogram (OR 0.06, CI 0.02-0.14), and a family history of breast cancer (OR 0.44, CI 0.22-0.89).
  
  
  CONCLUSIONS
  To maximize return for follow-up among low-income women with a breast abnormality, clear information should be provided about where to obtain care, particularly to patients in hospital settings. The importance of complete and timely follow-up care should be emphasized, especially with referrals for clinical breast examinations or 6-month mammograms.
authors.affiliation: Medical Effectiveness Research Center, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, California 94143-0856, USA. ckaplan@itsa.ucsf.edu
authors.forename: Celia Patricia
authors.initials: CP
authors.lastname: Kaplan
authors.forename: Lori A
authors.initials: LA
authors.lastname: Crane
authors.forename: Susan
authors.initials: S
authors.lastname: Stewart
authors.forename: Maria
authors.initials: M
authors.lastname: Juarez-Reyes
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D002140:California / Q000453:epidemiology; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000379:methods; D008875:Middle Aged; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors; D016387:Women's Health