Journal Article

Extent of Follow-Up on Abnormal Cancer Screening in Multiple California Public Hospital Systems: A Retrospective Review

Pacca, Lucia, Whitezell, Tyler, Somsouk, Ma, Lown, David, Sarkar, Urmimala, Gupta, Neha, Khoong, Elaine C., Rivadeneira, Natalie A., Babaria, Palav, Pramanik, Rajiv, Tran, Helen, Schillinger, Dean

2023

Overview

Background Inequitable follow-up of abnormal cancer screening tests may contribute to racial/ethnic disparities in colon and breast cancer outcomes. However, few multi-site studies have examined follow-up of abnormal cancer screening tests and it is unknown if racial/ethnic disparities exist. Objective This report describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems. Design We conducted a retrospective cohort study using data from five California public hospital systems. We used multivariable robust Poisson regression analyses to examine whether patient-level factors or site predicted receipt of follow-up test. Main Measures Using data from five public hospital systems between July 2015 and June 2017, we assessed follow-up of two screening results: (1) colonoscopy after positive fecal immunochemical tests (FIT) and (2) tissue biopsy within 21 days after a BIRADS 4/5 mammogram. Key Results Of 4132 abnormal FITs, 1736 (42%) received a follow-up colonoscopy. Older age, Medicaid insurance, lack of insurance, English language, and site were negatively associated with follow-up colonoscopy, while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 1082 (64%) received a timely biopsy; only site was associated with timely follow-up biopsy. Conclusion Despite the vulnerabilities of public-hospital-system patients, follow-up of abnormal cancer screening tests occurs at rates similar to that of patients in other healthcare settings, with colon cancer screening test follow-up occurring at lower rates than follow-up of breast cancer screening tests. Site-level factors have larger, more consistent impact on follow-up rates than patient sociodemographic traits. Resources are needed to identify health system–level factors, such as test follow-up processes or data infrastructure, that improve abnormal cancer screening test follow-up so that effective health system–level interventions can be evaluated and disseminated.

• Publisher: Springer International Publishing,Springer Nature B.V
• Subject: Biopsy / Breast cancer / Breast Neoplasms - diagnosis / California - epidemiology / Cancer screening / Colon / Colon cancer / Colonoscopy / Colorectal cancer / Colorectal Neoplasms - diagnosis / Cultural differences / Early Detection of Cancer / Female / Follow-Up Studies / Government programs / Hospital systems / Humans / Insurance / Internal Medicine / Mammography / Medical screening / Medicine / Medicine & Public Health / Minority & ethnic groups / Original Research / Patients / Regression analysis / Retrospective Studies / Robustness (mathematics)