Barriers to Diagnostic Resolution After Abnormal Mammography: A Review of the Literature

Debra Wujcik, PhD, RN, AOCN; Alecia Malin Fair, DrPH, CHES

Disclosures

Cancer Nurs. 2008;31(5):E16-E30. 

In This Article

Abstract and Introduction

Abstract

Breast cancer remains the most common cancer in women, and screening mammography is the best method for early detection. Approximately 10% to 15% of women undergoing screening mammography have abnormal or incomplete findings that require further diagnostic studies. The time to follow up is reported to be between 9 weeks and more than 19 weeks. Evidence indicates that a delay of more than 3 months in women with symptomatic breast cancer is associated with increased rates of breast cancer recurrence and death. The reasons for the delay are varied, and study findings suggest that minority and low-income women experience more delays than other groups do. The results from 22 studies are summarized. The identified barriers to completion of screening mammography were grouped as patient, provider, and system categories. Most of the studies were descriptive, retrospective studies that describe and measure the barriers in varied ways. Patient barriers were the most extensively described barrier, with little attention given to specific provider and system barriers. Women of nonwhite race with lack of insurance emerged as a subgroup that experienced more delay after abnormal or incomplete results. Provider and system barriers are also not well documented, and further exploration of these barriers is also recommended.

Introduction

Breast cancer remains the most common cancer and the second highest cause of cancer deaths in women, although the rise in incidence and mortality rates has gradually slowed since the sharp rise in the 1980s.[1] Screening mammography is especially valuable for early detection of breast cancer because it can diagnose breast cancer at an early stage, often before a lump is felt by the woman, or on clinical breast examination (CBE). The percentage of women diagnosed with breast cancer after screening mammography ranges from 4% to 7%.[2,3]

Approximately 10% to 15% of women undergoing screening mammography have abnormal or incomplete findings that require further diagnostic studies,[2] and approximately half of these women never return to complete the diagnostic testing.[4,5,6] Incomplete results indicate a radiologic finding that cannot be ruled either as normal, benign, or potentially malignant. For women who return, the time to resolution after abnormal screening mammography is reported to be less than 4 weeks[7] to more than a year.[8] There is evidence that indicates that a delay of more than 12 weeks in women who present to the physician with a breast lump leads to increased rates of breast cancer recurrence and death.[9]

The purpose of this review was to examine barriers to diagnostic follow-up after screening mammography. Barriers were grouped into patient, provider, and system categories. Identified barriers were assessed for their association with delayed diagnostic mammography.

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