title: Follow-Up of Abnormal Breast and Colorectal Cancer Screening by Race/Ethnicity.
abstract: Timely follow-up of abnormal tests is critical to the effectiveness of cancer screening, but may vary by screening test, healthcare system, and sociodemographic group.
  
  
  
  Timely follow-up of abnormal mammogram and fecal occult blood testing or fecal immunochemical tests (FOBT/FIT) were compared by race/ethnicity using Population-Based Research Optimizing Screening through Personalized Regimens consortium data. Participants were women with an abnormal mammogram (aged 40-75 years) or FOBT/FIT (aged 50-75 years) in 2010-2012. Analyses were performed in 2015. Timely follow-up was defined as colonoscopy ≤3 months following positive FOBT/FIT; additional imaging or biopsy ≤3 months following Breast Imaging Reporting and Data System Category 0, 4, or 5 mammograms; or ≤9 months following Category 3 mammograms. Logistic regression was used to model receipt of timely follow-up adjusting for study site, age, year, insurance, and income.
  
  
  
  Among 166,602 mammograms, 10.7% were abnormal; among 566,781 FOBT/FITs, 4.3% were abnormal. Nearly 96% of patients with abnormal mammograms received timely follow-up versus 68% with abnormal FOBT/FIT. There was greater variability in receipt of follow-up across healthcare systems for positive FOBT/FIT than for abnormal mammograms. For mammography, black women were less likely than whites to receive timely follow-up (91.8% vs 96.0%, OR=0.71, 95% CI=0.51, 0.97). For FOBT/FIT, Hispanics were more likely than whites to receive timely follow-up than whites (70.0% vs 67.6%, OR=1.12, 95% CI=1.04, 1.21).
  
  
  
  Timely follow-up among women was more likely for abnormal mammograms than FOBT/FITs, with small variations in follow-up rates by race/ethnicity and larger variation across healthcare systems.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: amccarthy8@partners.org.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: McCarthy
authors.affiliation: Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Elisabeth F
authors.initials: EF
authors.lastname: Beaber
authors.affiliation: Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Yingye
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Division of Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado.
authors.forename: Andrea
authors.initials: A
authors.lastname: Burnett-Hartman
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Jessica
authors.initials: J
authors.lastname: Chubak
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
authors.forename: Nirupa R
authors.initials: NR
authors.lastname: Ghai
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Dale
authors.initials: D
authors.lastname: McLerran
authors.affiliation: Health Systems and Interventions Research Branch, National Cancer Institute, Bethesda, Maryland.
authors.forename: Nancy
authors.initials: N
authors.lastname: Breen
authors.affiliation: Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Emily F
authors.initials: EF
authors.lastname: Conant
authors.affiliation: Department of Family Medicine, University of Vermont, Burlington, Vermont.
authors.forename: Berta M
authors.initials: BM
authors.lastname: Geller
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Beverly B
authors.initials: BB
authors.lastname: Green
authors.affiliation: Office of Disease Prevention, NIH, Bethesda, Maryland.
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.affiliation: Department of Health Policy and History of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Health Policy and Management, Mount Saint Mary's University, Los Angeles, California.
authors.forename: Stephen
authors.initials: S
authors.lastname: Inrig
authors.affiliation: Department of Clinical Science and Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Celette Sugg
authors.initials: CS
authors.lastname: Skinner
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.affiliation: Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Schnall
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, Washington.
authors.forename: William E
authors.initials: WE
authors.lastname: Barlow
authors.affiliation: Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, California.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Corley
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Katrina
authors.initials: K
authors.lastname: Armstrong
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Chyke A
authors.initials: CA
authors.lastname: Doubeni
mesh_terms: D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data*; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology; D005260:Female; D006801:Humans; D008327:Mammography; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009780:Occult Blood