Low-income women offered appropriate follow-up after abnormal mammogram

Analysis of data collected by the Massachusetts Breast and Cervical Cancer Early Detection Program showed that the implementation of case management resulted in low-income participants experiencing significant decreases in time from abnormal mammogram to diagnostic testing and more appropriate treatment.

Congress established the Breast and Cervical Cancer Early Detection Program in 1990 to reduce barriers to breast cancer detection by funding screening and diagnostic services for women traditionally underserved by the medical system. Case management was implemented into this program in 2001 to address barriers to follow-up care after abnormal mammograms, and free treatment was introduced in 2004.

Researchers examined records collected on 2,252 women eligible for case management from July 1998 through March 2007.

The researchers said median time from mammogram to diagnostic resolution decreased by eight days after the case management period and by another four days from the post-case management period to the post-free treatment period.

Additionally, the time from abnormal mammogram to the start of treatment decreased by 12 days after the case management period and by another three days from the post-case management period to the post-free treatment period.

Researchers said the proportion of women with diagnostic delay decreased by 10 percentage points — from 33% experiencing delay to 23% experiencing delay — after case management was implemented and by an additional three percentage points after the start of free treatment. There was a 35% decrease in the adjusted risk for diagnostic delay during the case management period and an additional nonstatistically significant 7% decrease in the risk of diagnostic delay after the implementation of free treatment.

Lobb R. Arch Intern Med. 2010;170;doi:10.1001/archinternmed.2010.22.