Abnormal screening mammogram follow-up: Improving time and timeliness benchmarks.

Abstract

Background: Abnormal screening mammograms cause significant patient distress. Current benchmarks for timeliness of care for additional imaging after abnormal screening assess the time interval from screening to initial follow-up imaging. We sought to investigate the overall length of time required for imaging resolution after abnormal screening mammogram. Methods: We performed a retrospective review of women undergoing screening mammograms during a two month period at a tertiary-care institution. The main outcome measure was calendar days (d) between dates of screening mammogram and imaging resolution (final additional imaging or percutaneous biopsy). Results: From 1,133 sequential screening mammograms, 237 (20.9%) patients required at least one recall study. Median patient age was 55 years (28-92). Of patients requiring call back exams, 68.7% required only one recall; however, 23.6% required two; 6.3% required three; 0.8 % required four; and 0.04% required five. The overall median time for resolution of abnormal screening mammogram was 22 d (range 0-405). The time for resolution was significantly longer for women with a prior history of breast cancer than those without (35.5 d vs. 21 d, p=0.04), and in women with mass lesions compared to those with calcifications or a focal asymmetry (34 d vs. 22 d and 20 d, respectively, p=0.01). Time to resolution for patients requiring one recall was 14 d, two recalls was 42.5 d, three recalls was 49 d, four recalls was 68 d, and five recalls was 203 d (p<0.0001). There was no significant difference in time to resolution of abnormal screening mammogram based on patient age, race/ethnicity, BMI, insurance type, breast density, or individual radiologist. Conclusions: While most patients with abnormal mammograms had a single call back and resolution of imaging findings within two weeks of screening, a significant proportion of women required more prolonged imaging follow up. Patients with a history of breast cancer and those who present with mass lesions should be targeted for quality improvement. Benchmarks evaluating the overall time required for resolution of imaging findings may better represent the patient experience.