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Delays in Follow-Up Imaging More Likely for Women Without Insurance

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The U.S. Centers for Disease Control and Prevention guidelines recommend that a woman who has positive results on a screening mammogram, suggesting that cancer is present, should have a follow-up diagnostic exam within 60 days of the positive screening results. A follow-up diagnostic exam could include another mammogram, breast ultrasound, breast MRI, or breast biopsy. Delays in follow-up have been linked to worse disease outcomes.

A study suggests that women younger than 65 who don’t have health insurance are more likely than insured women to experience delays in follow-up exams.

The research was published in the November issue of the journal Cancer Epidemiology, Biomarkers & Prevention. Read the abstract of “Insurance-Based Differences in Time to Diagnostic Follow-up after Positive Screening Mammography.”

To do the study, the researchers looked at information in the Carolina Mammography Registry, a North Carolina registry of breast imaging and cancer outcomes. The 43,026 women in the study had an initial positive screening mammogram between 1995 and 2010:

  • 73% of the women were younger than 65; 89% of these women had private insurance, 3% had no insurance, and the rest had a combination of Medicare and private insurance
  • 27% were 65 or older

The researchers looked at how many women had follow-up after the positive screening mammogram and sorted the information by age and insurance status.

The researchers found that uninsured women who were younger than 65 had a longer time between a positive screening mammogram and a follow-up exam compared to women who had insurance and women who were 65 or older. Women younger than 65 with no insurance were 59% more likely to miss the Centers for Disease Control and Prevention recommendation on follow-up time than women of the same age who had private insurance.

Among women younger than 65:

  • 18% of women without insurance had more than 60 days between the initial positive screening mammogram and the follow-up exam
  • 11% of women with insurance had more than 60 days between the initial positive screening mammogram and the follow-up exam
  • nearly 14% of women with no insurance had no follow-up in the year after the initial positive screening mammogram

"If a woman experiences a positive screening mammogram and is called back for a follow-up diagnostic test, it's important that it gets taken care of in a timely fashion," said Louise Henderson, assistant professor of radiology at the University of North Carolina and lead author of the study. "We want to encourage women to be aware that an abnormal result in a screening mammogram is not necessarily an emergency, but it must be resolved. The women with no insurance are consistently a little bit behind in terms of follow-up, and we need to work toward addressing that gap to ensure better outcomes for these women."

If your annual screening mammogram returns positive results, it makes sense to have a follow-up exam as soon as you can. Finding breast cancer early reduces your risk of dying from the disease by 25-30% or more. There’s only one of you and you deserve the best care possible. If you’re worried about cost, talk to your doctor, a local hospital social worker, or staff members at a mammogram center. Together, you can develop a follow-up plan that is best for your unique situation.

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