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

• Published in: Journal of general internal medicine : JGIM 2023-01, Vol.38 (1), p.21-29
• Main Authors: Khoong, Elaine C., Rivadeneira, Natalie A., Pacca, Lucia, Schillinger, Dean, Lown, David, Babaria, Palav, Gupta, Neha, Pramanik, Rajiv, Tran, Helen, Whitezell, Tyler, Somsouk, Ma, Sarkar, Urmimala
• Format: Article
• Language: English
• Subjects: 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)
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-022-07657-4

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.