title: Language barriers, location of care, and delays in follow-up of abnormal mammograms.
abstract: BACKGROUND
  Breast cancer is frequently diagnosed after an abnormal mammography result. Language barriers can complicate communication of those results.
  
  
  OBJECTIVE
  We evaluated the association of non-English language with delay in follow-up.
  
  
  METHODS
  Retrospective cohort study of women at 3 mammography facilities participating in the San Francisco Mammography Registry with an abnormal mammogram result from 1997 to 2008. We measured median time from report of abnormal result to first follow-up test.
  
  
  RESULTS
  Of 13,014 women with 16,109 abnormal mammograms, 4027 (31%) had a non-English patient language. Clinical facilities differed in proportion of non-English speakers and in time to first follow-up test: facility A (38%; 25 d), facility B (18%; 14 d), and facility C (51%; 41 d). Most mammography examinations (67%) had breast imaging and reporting data system 0 (incomplete) assessment, requiring radiographic follow-up. At 30 days of follow-up, 67% of all English speakers with incomplete assessments had a follow-up examination compared with 50% of all non-English speakers (P<0.0001). The facility with the least delay and the lowest proportion of non-English speakers, had the biggest difference by language; compared with English speakers and adjusting for education, non-English speakers had twice the odds ratio of >30-day delay in follow-up (odds ratio=2.3; 95% confidence interval, 1.4-3.9).
  
  
  CONCLUSIONS
  There are considerable differences among facilities in delays in diagnostic follow-up of abnormal mammography results. More attention must be paid to understanding mammography facility factors, such as wait time to schedule diagnostic mammography and radiology workload, to improve rates of timely follow-up, particularly for those facilities disproportionately serving vulnerable non-English speaking patients.
authors: Department of Medicine, Medical Effectiveness Research Center for Diverse Populations, San Francisco, CA, USA. Leah.karliner@ucsf.edu
authors: Leah S
authors: LS
authors: Karliner
authors: Lin
authors: L
authors: Ma
authors: Michael
authors: M
authors: Hofmann
authors: Karla
authors: K
authors: Kerlikowske
mesh_terms: D000328:Adult; D000368:Aged; D001941:Breast Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007802:Language; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012495:San Francisco; D013997:Time Factors