title: Timing of follow-up after abnormal screening and diagnostic mammograms.
abstract: OBJECTIVE
  To evaluate woman-level characteristics associated with timing of follow-up after abnormal mammograms in an integrated healthcare system with an active breast health program.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  The study included women aged 40-84 years who had an abnormal mammogram (20,060 screening and 3184 diagnostic) recommended for follow-up. We compared characteristics of women who received any follow-up evaluation within <7, 8 to 14, 15 to 21, and 22 to 180 days. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariate ordinal logistic regression.
  
  
  RESULTS
  The proportion of women seeking care within 7 days was 23% for screening and 69% for diagnostic mammograms. Characteristics associated with later follow-up (>8 days vs <7 days) after an abnormal screening mammogram included being older (OR=1.15; 95% CI, 1.04-1.26 [age 70-79 years]; OR=1.31; 95% CI, 1.14-1.51 [age 80+ years]), Asian (OR=1.18; 95% CI, 1.04-1.33), or having a college degree (OR=1.10; 95% CI, 1.01-1.19). Characteristics associated with earlier follow-up included family history of breast cancer (OR=0.93; 95% CI, 0.88-0.98), symptoms at time of mammogram (OR=0.79; 95% CI, 0.70-0.88), or extremely dense breasts (OR=0.82; 95% CI, 0.69-0.96). For diagnostic mammograms, symptoms at time of mammogram (OR=0.47; 95% CI, 0.39-0.56) and being obese (OR=0.79; 95% CI, 0.65-0.98) were associated with earlier follow-up.
  
  
  CONCLUSIONS
  Several woman-level characteristics were associated with timely follow-up after an abnormal screening exam, but only presence of symptoms and being obese was associated with timely follow-up after an abnormal diagnostic exam.
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101, USA. wernli.k@ghc.org
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Wernli
authors.forename: Erin J
authors.initials: EJ
authors.lastname: Aiello Bowles
authors.forename: Sebastien
authors.initials: S
authors.lastname: Haneuse
authors.forename: Joanne G
authors.initials: JG
authors.lastname: Elmore
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000517:prevention & control; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014861:Washington