Factors Associated With Optimal Follow-up in Women With BI-RADS 3 Breast Findings

Abstract

Objective: Assess rate of and factors associated with optimal follow-up in patients with BI-RADS 3 breast findings. Methods: This Institutional Review Board-approved, retrospective cohort study, performed at an academic medical center, included all women undergoing breast imaging (ultrasound and mammography) in 2016. Index reports for unique patients with an assessment of BI-RADS 3 (retrieved via natural language processing) comprised the study population. Patient-specific and provider-related features were extracted from the Research Data Warehouse. The Institutional Cancer Registry identified patients diagnosed with breast cancer. Optimal follow-up rate was calculated as patients with follow-up imaging on the same breast 3–9 months from the index exam among patients with BI-RADS 3 assessments. Univariate analysis and multivariable logistic regression determined features associated with optimal follow-up. Malignancy rate and time to malignancy detection was recorded. Results: Among 93,685 breast imaging exams, 64,771 were from unique patients of which 2,967 had BI-RADS 3 findings (4.6%). Excluding patients with off-site index exams and those with another breast exam <3 months from the index, 1,125 of 1,511 patients (74%) had optimal follow-up. In univariate and multivariable analysis, prior breast cancer was associated with optimal follow-up; younger age, Hispanic ethnicity, divorced status, and lack of insurance with not having optimal follow-up. Malignancy rate=0.86%; mean time to detection=330 days. Discussion: Follow-up of BI-RADS 3 breast imaging findings is optimal in only 74% of women. Further interventions to promote follow-up should target younger, unmarried women, those with Hispanic ethnicity, and women without history of breast cancer and without insurance coverage.

Exacerbation of Inequities in Use of Diagnostic Radiology During the Early Stages of Reopening After COVID-19

“…Pre-COVID-19, Hispanic ethnicity had been identified in several studies to be significantly associated with delays in diagnostic imaging [ 13 , 22 ]. However, more conflicting results have been seen with Asian patients and diagnostic radiology examination follow-ups [ 19 ].…”

“…However, more conflicting results have been seen with Asian patients and diagnostic radiology examination follow-ups [ 19 ]. In breast imaging, for instance, Asian women were significantly more likely to have timely follow-ups compared with White women [ 13 ]. Patients of Asian ethnicity have been reported to have higher levels of subjective fear of COVID-19 [ 23 ], which may in part account for our finding.…”

“…The COVID-19 pandemic is also highlighting deep pre-existing inequities in health care delivery in the United States [ 9 ], including in radiology [ 10 , 11 ]. Social determinants of health such as race, ethnicity, and socio-economic status are known to affect screening and follow-up for conditions such as breast cancer and lung cancer [ 12 , 13 ] and have been associated with delayed disease presentations in some vulnerable groups [ 14 , 15 ]. Some clinical specialties have begun to identify additional potential deleterious effects of delayed care for patients of low socio-economic status, from racial and ethnic minority groups, patients with limited English proficiency, and the uninsured [ 16 ].…”

“…Although social determinants of health were identified as factors that influence diagnostic radiology examination utilization prepandemic [ 13 , 15 ], this has not been explicitly addressed in the early stages of the COVID-19 pandemic [ 17 ]. Therefore, the purpose of this study was to assess diagnostic radiology examination utilization and associated social determinants of health during early stages of reopening after state-mandated shutdown of nonurgent services due to COVID-19.…”

Imaging Utilization During the COVID-19 Pandemic Highlights Socioeconomic Health Disparities

“…Additionally, the economic downturn caused by the pandemic resulted in high rates of unemployment and loss of medical insurance [10], which may have disproportionately impacted those patients with prior commercial insurance and lower-income households. However, we also consider the possibility that these findings can be explained by the pre-existing disparities related to imaging services reported in the literature [11], in particular to cancer screening and follow-up imaging [12,13]. If this is indeed the case, this delayed care may lead to potential adverse health consequences for these populations.…”