title: Frequency and Determinants of a Short-Interval Follow-up Recommendation After an Abnormal Screening Mammogram.
abstract: OBJECTIVE
  After imaging assessment of an abnormal screening mammogram, a follow-up examination 6 months later is recommended to some women. Our aim was to identify which characteristics of lesions, women, and physicians are associated to such short-interval follow-up recommendation in the Quebec Breast Cancer Screening Program.
  
  
  METHODS
  Between 1998 and 2008, 1,839,396 screening mammograms were performed and a total of 114,781 abnormal screens were assessed by imaging only. Multivariate analysis was done with multilevel Poisson regression models with robust variance and generalized linear mixed models.
  
  
  RESULTS
  A short-interval follow-up was recommended in 26.7% of assessments with imaging only, representing 2.3% of all screens. Case-mix adjusted proportion of short-interval follow-up recommendations varied substantially across physicians (range: 4%-64%). Radiologists with high recall rates (≥15%) had a high proportion of short-interval follow-up recommendation (risk ratio: 1.82; 95% confidence interval: 1.35-2.45) compared to radiologists with low recall rates (<5%). The adjusted proportion of short-interval follow-up was high (22.8%) even when a previous mammogram was usually available.
  
  
  CONCLUSIONS
  Short-interval follow-up recommendation at assessment is frequent in this Canadian screening program, even when a previous mammogram is available. Characteristics related to radiologists appear to be key determinants of short-interval follow-up recommendation, rather than characteristics of lesions or patient mix. Given that it can cause anxiety to women and adds pressure on the health system, it appears important to record and report short-interval follow-up and to identify ways to reduce its frequency. Short-interval follow-up recommendations should be considered when assessing the burden of mammography screening.
authors.affiliation: Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada. Electronic address: eric.pelletier@inspq.qc.ca.
authors.forename: Eric
authors.initials: E
authors.lastname: Pelletier
authors.affiliation: Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Daigle
authors.affiliation: Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada.
authors.forename: Fannie
authors.initials: F
authors.lastname: Defay
authors.affiliation: Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Major
authors.affiliation: Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Guertin
authors.affiliation: Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec, Canada; Centre de recherche du Centre hospitalier universitaire de Québec, Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Brisson
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011792:Quebec; D011871:Radiology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020379:Risk Adjustment; D013997:Time Factors
keywords: Breast cancer; Mammography; Mass screening; Short-interval follow-up