TY - JOUR
T1 - Variations in pathways and resource use in follow-up after abnormal mammography screening
T2 - a nationwide register-based study
AU - Jørgensen, Susanne Fogh
AU - Andersen, Berit
AU - Lernevall, Anders
AU - Rebolj, Matejka
AU - Njor, Sisse Helle
N1 - Funding Information:
This work was funded by Helsefonden (Grant Number: 16-B-0171). Matejka Rebolj was funded by Cancer Research UK (Grant Number: C8162/A27047). None of the funders were involved in the development of the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/9
Y1 - 2021/9
N2 - Purpose: Mammography screening reduces breast cancer mortality, but a successful screening programme depends on both high participation and a sufficient follow-up of abnormalities. This study investigated patterns of follow-up after abnormal screening mammography in Denmark, and whether the variation was associated with health care resource use. Methods: We included 19,458 women aged 50–69 years with an abnormal screening mammography during a 3-year period of 2014–2016. Women were followed until the end of 2018. Their follow-up pathway was categorized in terms of the timeliness, appropriateness (i.e. whether all recommended diagnostic tests were utilized), and the ratio of benign vs. malignant surgeries. Further, we estimated health care resource use including post-diagnostic imaging and surgery procedures. Results: Ninety-seven percent of women had a diagnostic follow-up test within 6 months and 94% of those had diagnostic procedures in accordance with the recommendations. The proportion with timely follow-up (i.e. within 1 month) was 83%, but varied significantly between administrative regions (p < 0.001), and also between women with a screen-detected cancer and those with a false-positive mammogram (87% vs. 81%, p < 0.001). The ratio between having a benign versus a malignant surgery was 1:8, but it varied depending on which tests were used for diagnosis. The average number of procedures was, generally, in accordance with the recommendations. Conclusion: In most cases, follow-up after abnormal screening mammography followed national recommendations. We nevertheless found that this was not always the case in certain subgroups and administrative regions.
AB - Purpose: Mammography screening reduces breast cancer mortality, but a successful screening programme depends on both high participation and a sufficient follow-up of abnormalities. This study investigated patterns of follow-up after abnormal screening mammography in Denmark, and whether the variation was associated with health care resource use. Methods: We included 19,458 women aged 50–69 years with an abnormal screening mammography during a 3-year period of 2014–2016. Women were followed until the end of 2018. Their follow-up pathway was categorized in terms of the timeliness, appropriateness (i.e. whether all recommended diagnostic tests were utilized), and the ratio of benign vs. malignant surgeries. Further, we estimated health care resource use including post-diagnostic imaging and surgery procedures. Results: Ninety-seven percent of women had a diagnostic follow-up test within 6 months and 94% of those had diagnostic procedures in accordance with the recommendations. The proportion with timely follow-up (i.e. within 1 month) was 83%, but varied significantly between administrative regions (p < 0.001), and also between women with a screen-detected cancer and those with a false-positive mammogram (87% vs. 81%, p < 0.001). The ratio between having a benign versus a malignant surgery was 1:8, but it varied depending on which tests were used for diagnosis. The average number of procedures was, generally, in accordance with the recommendations. Conclusion: In most cases, follow-up after abnormal screening mammography followed national recommendations. We nevertheless found that this was not always the case in certain subgroups and administrative regions.
KW - Breast cancer
KW - Diagnostic resolution
KW - Follow-up time
KW - Guideline adherence
KW - Screening
KW - Screening mammography
UR - http://www.scopus.com/inward/record.url?scp=85112223242&partnerID=8YFLogxK
U2 - 10.1007/s10549-021-06312-6
DO - 10.1007/s10549-021-06312-6
M3 - Article
C2 - 34196901
AN - SCOPUS:85112223242
SN - 0167-6806
VL - 189
SP - 551
EP - 560
JO - Breast Cancer Research and Treatment
JF - Breast Cancer Research and Treatment
IS - 2
ER -
