Women with abnormal screening mammography lost to follow-up

Abstract

Breast cancer has the highest incidence among all cancers for women in Taiwan. The current screening policy in Taiwan suggested a biennial mammography for all women 40 to 69 years of age. A recommendation for additional testing is recommended for women with a BI-RADS result of 0 or 4; a request made via postal mail. Approximately 20% of high-risk patients do not receive additional follow-up. Therefore, we aimed to explore the causes of these patients being lost to follow-up, despite an abnormal mammogram. Two questionnaires were designed separately according to the conceptual framework of the Health Belief Model. Study participants, women who received a screening mammography at the National Taiwan University Hospital in 2011 with a BI-RAD of 0 or 4, were interviewed via telephone. The dependent variable was receipt of follow-up or not. The analyses were performed by using χ2 tests and logistic regression models. In total, 528 women were enrolled in the study: 51.2% in BI-RADS 0 group and 56.6% in BI-RADS 4, respectively. In the BI-RADS 0 group, those patients who received a follow-up examination cited the most likely causes to be physician suggestion, health implications, and concerns regarding breast cancer. Patients who did not receive a follow-up examination cited a lack of time and a perception of good personal health as primary reasons. In the BI-RADS 4 group, those patients who received a follow-up examination cited the physician's recommendation and a recognition of the importance of follow-up examinations. Patients who did not receive a follow-up examination cited having received follow-up at another hospital and a desire for a second opinion. In the BI-RADS 0 group, multivariate analysis showed that patients with higher scores in the “perceived benefits” domain were statistically more likely to receive a follow-up examination. There was no significant difference in perceived threats, perceived barriers, action cues, or self-efficacy between groups. We conclude that additional education to raise breast cancer awareness in the general public and healthcare providers will be needed to improve the rate of follow-up examinations after an abnormal screening mammogram.

Experiences of Women Who Refuse Recall for Further Investigation of Abnormal Screening Mammography: A Qualitative Study

“…Such factors can affect whether a woman will be subject to regular inspections or further re-examinations. This is also consistent with the argument put forward by Kuo et al [2]; that is, unlike foreign private insurance, Taiwan provides universal health insurance coverage, which will affect people's screening and subsequent medical treatment.…”

“…The pull between "not going" and "going" for a re-examination shows that the perceived threat of breast cancer is low, which is similar to the results of Kuo et al [2], if the mammography result is BI-RADS 0. Likewise, in our study, the most likely reason for not receiving follow-up treatment was "thinking she was in good health and did not need to accept follow-up treatment".…”

“…In 2020, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths globally [1]. In Taiwan, where breast cancer has the highest incidence among all cancers in women, the incidence of breast cancer in 2018 was 78.86/100,000 [2,3], and Taiwan's rate was also the highest among Asian countries [4]. The mortality rate of breast cancer in Taiwan in 2018 was 12.34/100,000 [3].…”

“…However, about 92.3% of the cases with positive breast cancer screenings (BI-RADS 0, 3, 4, or 5) received a follow-up examination, leaving 7.7% of women with a high risk of breast cancer lost to follow-up [9]. Therefore, for early detection of breast cancer, it is of paramount importance to increase the follow-up rate in women with abnormal screening mammogram results [2,3].…”

Acompanhamento de mulheres rastreadas para o câncer de mama com lesões provavelmente benignas no estado do Rio de Janeiro

“…Para isso é necessário que essas mulheres sejam seguidas nos tempos indicados, o que nem sempre acontece. A literatura tem mostrado que 10% a 30% das mulheres rastreadas para o câncer de mama no Brasil e no mundo não são seguidas 6,7 .…”