RT Journal Article
SR Electronic
T1 Insurance-Based Differences in Time to Diagnostic Follow-up after Positive Screening Mammography
JF Cancer Epidemiology Biomarkers & Prevention
JO Cancer Epidemiol Biomarkers Prev
FD American Association for Cancer Research
SP 1474
OP 1482
DO 10.1158/1055-9965.EPI-16-0148
VO 25
IS 11
A1 Durham, Danielle D.
A1 Robinson, Whitney R.
A1 Lee, Sheila S.
A1 Wheeler, Stephanie B.
A1 Reeder-Hayes, Katherine E.
A1 Bowling, J. Michael
A1 Olshan, Andrew F.
A1 Henderson, Louise M.
YR 2016
UL http://cebp.aacrjournals.org/content/25/11/1474.abstract
AB Background: Insurance may lengthen or inhibit time to follow-up after positive screening mammography. We assessed the association between insurance status and time to initial diagnostic follow-up after a positive screening mammogram.Methods: Using 1995–2010 data from a North Carolina population-based registry of breast imaging and cancer outcomes, we identified women with a positive screening mammogram. We compared receipt of follow-up within 60 days of screening using logistic regression and evaluated time to follow-up initiation using Cox proportional hazards regression.Results: Among 43,026 women included in the study, 73% were <65 years and 27% were 65+ years. Median time until initial diagnostic follow-up was similar by age group and insurance status. In the adjusted model for women <65, uninsured women experienced a longer time to initiation of diagnostic follow-up [HR, 0.47; 95% confidence interval (CI), 0.25–0.89] versus women with private insurance. There were increased odds of these uninsured women not meeting the Centers for Disease Control and Prevention guideline for follow-up within 60 days (OR, 1.59; 95% CI, 1.31–1.94). Among women ages 65+, women with private insurance experienced a faster time to follow-up (adjusted HR, 2.09; 95% CI, 1.27–3.44) than women with Medicare and private insurance. Approximately 10% of women had no follow-up by 365 days.Conclusions: We found differences in time to initial diagnostic follow-up after a positive screening mammogram by insurance status and age group. Uninsured women younger than 65 years at a positive screening event had delayed follow-up.Impact: Replication of these findings and examination of their clinical significance warrant additional investigation. Cancer Epidemiol Biomarkers Prev; 25(11); 1474–82. ©2016 AACR.This article is featured in Highlights of This Issue, p. 1447