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Delay in Diagnostic Testing After Abnormal Mammography in Low-Income Women

Debra Wujcik
Yu Shyr
Ming Li
Margaret F. Clayton
Lee Ellington
Usha Menon
Kathi Mooney
ONF 2009, 36(6), 709-715 DOI: 10.1188/09.ONF.709-715

Purpose/Objectives: To identify factors associated with diagnostic delay after an incomplete or abnormal mammogram among women participating in a state mammography screening program.

Research Approach: Retrospective case-control design using bivariate and multivariate logistic regression analyses to explore the associations between age, race, ethnicity, marital status, breast cancer history, and self-reported breast symptoms and delay.

Setting: A statewide program of free screening mammography for women who are under- or uninsured.

Participants: 11,460 women enrolled in a free, statewide screening program from 2002-2006.

Methodologic Approach: Using the Tennessee Breast and Cervical Cancer Screening Program database, further analyses were conducted.

Main Research Variables: The outcome measure was delay in completion of all diagnostic tests and was defined as women who did not complete testing within 60 days.

Findings: Thirty-seven percent of women required follow-up, and of a subset used in the analysis, 30% experienced delay of more than 60 days. Controlling for marital status, age, and breast cancer history, women who experienced delay were more likely to be African American versus Caucasian (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.13, 1.85) or Hispanic (OR = 0.72, 95% CI = 0.55, 0.93) and to have self-reported breast symptoms (OR = 1.50, 95% CI = 1.27, 1.77).

Conclusions: In a sample of women with low income needing mammography follow-up, delay was associated with three intrapersonal variables, potentially reducing the effectiveness of mammography screening for women who were African American, or Hispanic, or had self-reported breast symptoms.

Interpretation: Nurses providing cancer screening examinations are uniquely positioned to assess the knowledge, beliefs, and resources of women using the program and to navigate women through barriers to completion. Knowledge of factors associated with delay is valuable for planning interventions and allocating program resources.

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