Improving work-up of the abnormal mammogram through organized assessment: results from the ontario breast screening program.
OBJECTIVE
Women with an abnormal screening mammogram should ideally undergo an organized assessment to attain a timely diagnosis. This study evaluated outcomes of women undergoing work-up after abnormal mammogram through a formal breast assessment affiliate (BAA) program with explicit care pathways compared with usual care (UC) using developed quality indicators for screening mammography programs.


METHODS
Between January 1 and December 31, 2007, a total of 320,635 women underwent a screening mammogram through the Ontario Breast Screening Program (OBSP), of whom 25,543 had an abnormal result requiring further assessment. Established indicators assessing timeliness, appropriateness of follow-up, and biopsy rates were compared between women who were assessed through either a BAA or UC using χ(2) analysis.


RESULTS
Work-up of the abnormal mammogram for patients screened through a BAA resulted in a greater proportion of women attaining a definitive diagnosis within the recommended time interval when a histologic diagnosis was required. In addition, use of other quality measures including specimen radiography for both core biopsies and surgical specimens and preoperative core needle biopsy was greater in BAA facilities.


CONCLUSIONS
These findings support future efforts to increase the number of BAAs within the OBSP, because the pathways and reporting methods associated with them result in improvements in our ability to provide timely and appropriate care for women requiring work-up of an abnormal mammogram.
Foothills Medical Center, University of Calgary, Calgary, Alberta; Cancer Care Ontario; Dalla Lana School of Public Health, University of Toronto; Sunnybrook Health Sciences Centre, University of Toronto; and St Michaels Hospital, University of Toronto, Toronto, Ontario, Canada.
May Lynn
ML
Quan
Rene S
RS
Shumak
Vicky
V
Majpruz
Claire M D
CM
Holloway
Frances P
FP
O'Malley
Anna M
AM
Chiarelli