Rapid Communication| Volume 51, ISSUE 4, P507-512, October 2016

Follow-Up of Abnormal Breast and Colorectal Cancer Screening by Race/Ethnicity


      Timely follow-up of abnormal tests is critical to the effectiveness of cancer screening, but may vary by screening test, healthcare system, and sociodemographic group.


      Timely follow-up of abnormal mammogram and fecal occult blood testing or fecal immunochemical tests (FOBT/FIT) were compared by race/ethnicity using Population-Based Research Optimizing Screening through Personalized Regimens consortium data. Participants were women with an abnormal mammogram (aged 40–75 years) or FOBT/FIT (aged 50–75 years) in 2010–2012. Analyses were performed in 2015. Timely follow-up was defined as colonoscopy ≤3 months following positive FOBT/FIT; additional imaging or biopsy ≤3 months following Breast Imaging Reporting and Data System Category 0, 4, or 5 mammograms; or ≤9 months following Category 3 mammograms. Logistic regression was used to model receipt of timely follow-up adjusting for study site, age, year, insurance, and income.


      Among 166,602 mammograms, 10.7% were abnormal; among 566,781 FOBT/FITs, 4.3% were abnormal. Nearly 96% of patients with abnormal mammograms received timely follow-up versus 68% with abnormal FOBT/FIT. There was greater variability in receipt of follow-up across healthcare systems for positive FOBT/FIT than for abnormal mammograms. For mammography, black women were less likely than whites to receive timely follow-up (91.8% vs 96.0%, OR=0.71, 95% CI=0.51, 0.97). For FOBT/FIT, Hispanics were more likely than whites to receive timely follow-up than whites (70.0% vs 67.6%, OR=1.12, 95% CI=1.04, 1.21).


      Timely follow-up among women was more likely for abnormal mammograms than FOBT/FITs, with small variations in follow-up rates by race/ethnicity and larger variation across healthcare systems.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2008; 149: 627-637
      2. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2009; 151: 716-726
        • Levin B.
        • Lieberman D.A.
        • McFarland B.
        • et al.
        Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology.
        CA Cancer J Clin. 2008; 58: 130-160
        • Smith R.A.
        • Manassaram-Baptiste D.
        • Brooks D.
        • et al.
        Cancer screening in the United States, 2015: a review of current American Cancer Society guidelines and current issues in cancer screening.
        CA Cancer J Clin. 2015; 65: 30-54
        • Yabroff K.R.
        • Washington K.S.
        • Leader A.
        • Neilson E.
        • Mandelblatt J.
        Is the promise of cancer-screening programs being compromised? Quality of follow-up care after abnormal screening results.
        Med Care Res Rev. 2003; 60: 294-331
        • Zapka J.
        • Taplin S.H.
        • Price R.A.
        • Cranos C.
        • Yabroff R.
        Factors in quality care—the case of follow-up to abnormal cancer screening tests—problems in the steps and interfaces of care.
        J Natl Cancer Inst Monogr. 2010; 2010: 58-71
        • Wujcik D.
        • Shyr Y.
        • Li M.
        • et al.
        Delay in diagnostic testing after abnormal mammography in low-income women.
        Oncol Nurs Forum. 2009; 36: 709-715
        • Jones B.A.
        • Dailey A.
        • Calvocoressi L.
        • et al.
        Inadequate follow-up of abnormal screening mammograms: findings from the race differences in screening mammography process study (United States).
        Cancer Causes Control. 2005; 16: 809-821
        • Gorin S.S.
        • Heck J.E.
        • Cheng B.
        • Smith S.J.
        Delays in breast cancer diagnosis and treatment by racial/ethnic group.
        Arch Intern Med. 2006; 166: 2244-2252
        • Perez-Stable E.J.
        • Afable-Munsuz A.
        • Kaplan C.P.
        • et al.
        Factors influencing time to diagnosis after abnormal mammography in diverse women.
        J Womens Health (Larchmt). 2013; 22: 159-166
        • Warner E.T.
        • Tamimi R.M.
        • Hughes M.E.
        • et al.
        Time to diagnosis and breast cancer stage by race/ethnicity.
        Breast Cancer Res Treat. 2012; 136: 813-821
        • Wujcik D.
        • Fair A.M.
        Barriers to diagnostic resolution after abnormal mammography: a review of the literature.
        Cancer Nurs. 2008; 31: E16-E30
        • Ramirez A.G.
        • Perez-Stable E.J.
        • Talavera G.A.
        • et al.
        Time to definitive diagnosis of breast cancer in Latina and non-Hispanic white women: the Six Cities Study.
        Springerplus. 2013; 2: 84
        • Battaglia T.A.
        • Santana M.C.
        • Bak S.
        • et al.
        Predictors of timely follow-up after abnormal cancer screening among women seeking care at urban community health centers.
        Cancer. 2010; 116: 913-921
        • Mojica C.M.
        • Bastani R.
        • Ponce N.A.
        • Boscardin W.J.
        Latinas with abnormal breast findings: patient predictors of timely diagnostic resolution.
        J Womens Health (Larchmt). 2007; 16: 1468-1477
        • Kaplan C.P.
        • Crane L.A.
        • Stewart S.
        • Juarez-Reyes M.
        Factors affecting follow-up among low-income women with breast abnormalities.
        J Womens Health (Larchmt). 2004; 13: 195-206
        • Partin M.R.
        • Gravely A.
        • Gellad Z.F.
        • et al.
        Factors associated with missed and cancelled colonoscopy appointments at Veterans Health Administration facilities.
        Clin Gastroenterol Hepatol. 2016; 14: 259-267
        • Tosteson A.N.
        • Beaber E.F.
        • Tiro J.
        • et al.
        Variation in screening abnormality rates and follow-up of breast, cervical and colorectal cancer screening within the PROSPR consortium.
        J Gen Intern Med. 2016; 31: 372-379
        • Beaber E.F.
        • Kim J.J.
        • Schapira M.M.
        • et al.
        Unifying screening processes within the PROSPR consortium: a conceptual model for breast, cervical, and colorectal cancer screening.
        J Natl Cancer Inst. 2015; 107: djv120
        • Tiro J.A.
        • Kamineni A.
        • Levin T.R.
        • et al.
        The colorectal cancer screening process in community settings: a conceptual model for the population-based research optimizing screening through personalized regimens consortium.
        Cancer Epidemiol Biomarkers Prev. 2014; 23: 1147-1158
        • American College of Radiology
        Breast Imaging Reporting and Data System (BI-RADS).
        4th ed. American College of Radiology, Reston, VA2003
        • Miglioretti D.L.
        • Rutter C.M.
        • Bradford S.C.
        • et al.
        Improvement in the diagnostic evaluation of a positive fecal occult blood test in an integrated health care organization.
        Med Care. 2008; 46: S91-S96
        • Green B.B.
        • Anderson M.L.
        • Wang C.Y.
        • et al.
        Results of nurse navigator follow-up after positive colorectal cancer screening test: a randomized trial.
        J Am Board Fam Med. 2014; 27: 789-795
        • Fisher D.A.
        • Jeffreys A.
        • Coffman C.J.
        • Fasanella K.
        Barriers to full colon evaluation for a positive fecal occult blood test.
        Cancer Epidemiol Biomarkers Prev. 2006; 15: 1232-1235
        • Etzioni D.A.
        • Yano E.M.
        • Rubenstein L.V.
        • et al.
        Measuring the quality of colorectal cancer screening: the importance of follow-up.
        Dis Colon Rectum. 2006; 49: 1002-1010
        • Garman K.S.
        • Jeffreys A.
        • Coffman C.
        • Fisher D.A.
        Colorectal cancer screening, comorbidity, and follow-up in elderly patients.
        Am J Med Sci. 2006; 332: 159-163
        • Partin M.R.
        • Burgess D.J.
        • Burgess Jr., J.F.
        • et al.
        Organizational predictors of colonoscopy follow-up for positive fecal occult blood test results: an observational study.
        Cancer Epidemiol Biomarkers Prev. 2015; 24: 422-434
        • Partin M.R.
        • Powell A.A.
        • Nugent S.
        • Ordin D.L.
        Colorectal cancer diagnosis improvement project evaluation demonstrates the importance of using multiple measures to track progress toward timeliness goals.
        J Healthc Qual. 2013; 35: 41-48
        • Linver M.N.
        • Osuch J.R.
        • Brenner R.J.
        • Smith R.A.
        The mammography audit: a primer for the mammography quality standards act (MQSA).
        Am J Roentgenol. 1995; 165: 19-25
        • Green B.B.
        • Coronado G.D.
        • Devoe J.E.
        • Allison J.
        Navigating the murky waters of colorectal cancer screening and health reform.
        Am J Public Health. 2014; 104: 982-986
        • Doubeni C.A.
        The impact of colorectal cancer screening on the U.S. population: is it time to celebrate?.
        Cancer. 2014; 120: 2810-2813
        • Levin T.R.
        • Jamieson L.
        • Burley D.A.
        • Reyes J.
        • Oehrli M.
        • Caldwell C.
        Organized colorectal cancer screening in integrated health care systems.
        Epidemiol Rev. 2011; 33: 101-110