title: Variation in Screening Abnormality Rates and Follow-Up of Breast, Cervical and Colorectal Cancer Screening within the PROSPR Consortium.
abstract: BACKGROUND
  Primary care providers and health systems have prominent roles in guiding effective cancer screening.
  
  
  OBJECTIVE
  To characterize variation in screening abnormality rates and timely initial follow-up for common cancer screening tests.
  
  
  METHODS
  Population-based cohort undergoing screening in 2011, 2012, or 2013 at seven research centers comprising the National Cancer Institute-sponsored Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium.
  
  
  METHODS
  Adults undergoing mammography with or without digital breast tomosynthesis (n = 97,683 ages 40-75 years), fecal occult blood or fecal immunochemical tests (n = 759,553 ages 50-75 years), or Papanicolaou with or without human papillomavirus tests (n = 167,330 ages 21-65 years).
  
  
  METHODS
  Breast, colorectal, or cervical cancer screening.
  
  
  METHODS
  Abnormality rates per 1000 screens; percentage with timely initial follow-up (within 90 days, except 9-month window for BI-RADS 3). Primary care clinic-level variation in percentage with screening abnormality and percentage with timely initial follow-up.
  
  
  RESULTS
  There were 10,248/97,683 (104.9 per 1000) abnormal breast cancer screens, 35,847/759,553 (47.2 per 1000) FOBT/FIT-positive colorectal cancer screens, and 13,266/167,330 (79.3 per 1000) abnormal cervical cancer screens. The percentage with timely follow-up was 93.2 to 96.7 % for breast centers, 46.8 to 68.7  % for colorectal centers, and 46.6 % for the cervical cancer screening center (low-grade squamous intraepithelial lesions or higher). The primary care clinic variation (25th to 75th percentile) was smaller for the percentage with an abnormal screen (breast, 8.5-10.3 %; colorectal, 3.0-4.8 %; cervical, 6.3-9.9 %) than for the percentage with follow-up within 90 days (breast, 90.2-95.8 %; colorectal, 43.4-52.0 %; cervical, 29.6-61.4 %).
  
  
  CONCLUSIONS
  Variation in both the rate of screening abnormalities and their initial follow-up was evident across organ sites and primary care clinics. This highlights an opportunity for improving the delivery of cancer screening through focused study of patient, provider, clinic, and health system characteristics associated with timely follow-up of screening abnormalities.
authors.affiliation: Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. Anna.Tosteson@Dartmouth.edu.|Norris Cotton Cancer Center, Lebanon, NH, USA. Anna.Tosteson@Dartmouth.edu.
authors.forename: Anna N A
authors.initials: AN
authors.lastname: Tosteson
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Elisabeth F
authors.initials: EF
authors.lastname: Beaber
authors.affiliation: University of Texas Southwestern, Dallas, TX, USA.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Tiro
authors.affiliation: Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Kim
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: McCarthy
authors.affiliation: Kaiser Permanente Southern California, Pasadena, CA, USA.
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.affiliation: National Cancer Institute, Bethesda, MD, USA.
authors.forename: V Paul
authors.initials: VP
authors.lastname: Doria-Rose
authors.affiliation: University of New Mexico, Albuquerque, NM, USA.
authors.forename: Cosette M
authors.initials: CM
authors.lastname: Wheeler
authors.affiliation: Cancer Research and Biostatistics, Seattle, WA, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Barlow
authors.affiliation: Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Mackenzie
authors.initials: M
authors.lastname: Bronson
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Garcia
authors.affiliation: Kaiser Permanente Northern California, Oakland, CA, USA.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Corley
authors.affiliation: Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.affiliation: Group Health, Seattle, WA, USA.
authors.forename: Aruna
authors.initials: A
authors.lastname: Kamineni
authors.affiliation: RAND Corporation, Santa Monica, CA, USA.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.affiliation: Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.|Norris Cotton Cancer Center, Lebanon, NH, USA.
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.affiliation: University of Wisconsin, Madison, WI, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Trentham-Dietz
authors.affiliation: University of Vermont, Burlington, VT, USA.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Weaver
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods* / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult
keywords: breast cancer screening; cervical cancer screening; colorectal cancer screening; practice variation