Informing the Measurement of Timely Follow-Up on Inconclusive or Abnormal Screening Mammograms: An Environmental Scan
Marlika Marceaua✉, Omar Nafaaa, Carol Mitab, Lipika Samalc d, David Westfall Batesa c d e, Patricia C. Dykesc d, Ania Syrowatkac d
- aClinical and Quality Analysis, Mass General Brigham, Somerville, MA, United States
- bCountway Library of Medicine, Harvard Medical School, Boston, MA, United States
- cDivision of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
- dHarvard Medical School, Boston, MA, United States
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Abstract
This environmental scan aimed to inform specifications of an electronic clinical quality measure for timely diagnostic follow-up after inconclusive/abnormal screening mammograms through a review of current breast cancer screening practice standards. PubMed, UpToDate, and clinical quality measure databases were searched for relevant studies, guidelines, and measures, respectively. Data abstracted included screening eligibility criteria, screening and diagnostic modalities, impact of diagnostic delays, definitions for timely follow-up and performance benchmarks, follow-up rates, factors associated with missed or delayed follow-up, and specifications of informatics tools to measure follow-up. The results were narratively summarized. Twelve guidelines, 23 peer-reviewed articles, and five measures were included. Most guidelines recommended routine screening for average-risk females aged ≥ 40 years using 2D or 3D mammography. Recommended follow-up modalities were additional imaging (diagnostic mammography, breast ultrasound, breast magnetic resonance imaging) and breast biopsy. Five studies and one systematic review reported associations between longer wait times to follow-up and increased tumor sizes and lymph node metastases. Three studies defined timely follow-up as ≤ 60 days after an inconclusive/abnormal mammogram. Five studies and five measures used administrative health/electronic health record data to identify clinically eligible patients, primarily excluding patients requiring individualized care. Diagnostic follow-up rates ranged from 63.6% to 96.8% within 3 months across seven studies. Non-white patients, non-English speakers, and patients with lower educational attainment, lower socioeconomic status, and/or residence in rural/suburban settings had a higher risk of missed or delayed follow-up. A standard definition for timeliness of diagnostic follow-up after inconclusive/abnormal mammographic screening is needed to inform meaningful measurement and targeted interventions that improve clinical outcomes in the breast cancer screening process.