Insurance-Based Differences in Time to Diagnostic Follow-up after Positive Screening Mammography.
Insurance may lengthen or inhibit time to follow-up after positive screening mammography. We assessed the association between insurance status and time to initial diagnostic follow-up after a positive screening mammogram.



Using 1995-2010 data from a North Carolina population-based registry of breast imaging and cancer outcomes, we identified women with a positive screening mammogram. We compared receipt of follow-up within 60 days of screening using logistic regression and evaluated time to follow-up initiation using Cox proportional hazards regression.



Among 43,026 women included in the study, 73% were <65 years and 27% were 65+ years. Median time until initial diagnostic follow-up was similar by age group and insurance status. In the adjusted model for women <65, uninsured women experienced a longer time to initiation of diagnostic follow-up [HR, 0.47; 95% confidence interval (CI), 0.25-0.89] versus women with private insurance. There were increased odds of these uninsured women not meeting the Centers for Disease Control and Prevention guideline for follow-up within 60 days (OR, 1.59; 95% CI, 1.31-1.94). Among women ages 65+, women with private insurance experienced a faster time to follow-up (adjusted HR, 2.09; 95% CI, 1.27-3.44) than women with Medicare and private insurance. Approximately 10% of women had no follow-up by 365 days.



We found differences in time to initial diagnostic follow-up after a positive screening mammogram by insurance status and age group. Uninsured women younger than 65 years at a positive screening event had delayed follow-up.



Replication of these findings and examination of their clinical significance warrant additional investigation. Cancer Epidemiol Biomarkers Prev; 25(11); 1474-82. ©2016 AACR.
Department of Epidemiology, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, North Carolina.
Danielle D
DD
Durham
Department of Epidemiology, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, North Carolina.|Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina.
Whitney R
WR
Robinson
Department of Radiology, UNC School of Medicine, Chapel Hill, North Carolina.
Sheila S
SS
Lee
Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina.|Department of Health Policy and Management, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Stephanie B
SB
Wheeler
Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina.|Division of Hematology/Oncology, UNC School of Medicine, Chapel Hill, North Carolina.
Katherine E
KE
Reeder-Hayes
Department of Health Behavior, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Michael
JM
Bowling
Department of Epidemiology, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, North Carolina.|Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina.
Andrew F
AF
Olshan
Department of Epidemiology, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, North Carolina. louise_henderson@med.unc.edu.|Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina.|Department of Radiology, UNC School of Medicine, Chapel Hill, North Carolina.
Louise M
LM
Henderson
D000368:Aged; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008327:Mammography; D017057:Medically Uninsured; D006278:Medicare; D008875:Middle Aged; D009657:North Carolina; D013995:Time; D014481:United States