Delay in diagnostic testing after abnormal mammography in low-income women.
OBJECTIVE
To identify factors associated with diagnostic delay after an incomplete or abnormal mammogram among women participating in a state mammography screening program.


METHODS
Retrospective case-control design using bivariate and multivariate logistic regression analyses to explore the associations between age, race, ethnicity, marital status, breast cancer history, and self-reported breast symptoms and delay.


METHODS
A statewide program of free screening mammography for women who are under- or uninsured.


METHODS
11,460 women enrolled in a free, statewide screening program from 2002-2006.


METHODS
Using the Tennessee Breast and Cervical Cancer Screening Program database, further analyses were conducted.


METHODS
The outcome measure was delay in completion of all diagnostic tests and was defined as women who did not complete testing within 60 days.


RESULTS
Thirty-seven percent of women required follow-up, and of a subset used in the analysis, 30% experienced delay of more than 60 days. Controlling for marital status, age, and breast cancer history, women who experienced delay were more likely to be African American versus Caucasian (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.13, 1.85) or Hispanic (OR = 0.72, 95% CI = 0.55, 0.93) and to have self-reported breast symptoms (OR = 1.50, 95% CI = 1.27, 1.77).


CONCLUSIONS
In a sample of women with low income needing mammography follow-up, delay was associated with three intrapersonal variables, potentially reducing the effectiveness of mammography screening for women who were African American, or Hispanic, or had self-reported breast symptoms.


CONCLUSIONS
Nurses providing cancer screening examinations are uniquely positioned to assess the knowledge, beliefs, and resources of women using the program and to navigate women through barriers to completion. Knowledge of factors associated with delay is valuable for planning interventions and allocating program resources.
Wujcik
Debra
D
Vanderbilt-Ingram Cancer Center, School of Nursing, Vanderbilt University, Nashville, TN, USA. debbie.wujcik@vanderbilt.edu
Shyr
Yu
Y
Li
Ming
M
Clayton
Margaret F
MF
Ellington
Lee
L
Menon
Usha
U
Mooney
Kathi
K
D000328:Adult; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000451:nursing; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D015438:Health Behavior; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009859:Oncology Nursing; D011203:Poverty / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology; D013997:Time Factors