Predictors of delay to timely mammography resolution in minority and medically underserved women.

B155

Background: Previous studies have examined the relationship between behavioral risk factors such as tobacco smoking, alcohol intake and sedentary activity with the practice of screening mammography to detect breast cancer. Yet, few studies have investigated potential mediators of this association on timely follow-up of incomplete mammography results, an American College of Radiology (ACR) mammography status = 0 ("incomplete; needs additional imaging"), in minority and medically underserved patients. We examined this relationship in the Return After Mammography Study [RAMS], a case-control study of 34 women that did not complete or return for diagnostic treatment after a six month delay and 40 controls who returned for resolution within 3 months. Methods: The RAMS study sample was obtained by medical record abstraction of public hospital patients for an ACR=0 mammography event in 2003-2004. Telephone interviews were used to collect data on selected breast cancer risk factors and mammography screening beliefs. Multivariate logistic regression was used to evaluate the association between breast cancer risk factors and lifestyle patterns on return for incomplete mammography resolution. Results: Smoking status, alcohol intake, and physical activity levels were not significantly associated with return for resolution of an incomplete mammography. Weight status and reproductive history were significant predictors of a woman's likelihood of resolving an incomplete mammography. Obese patients (BMI > 30) were over two times more likely to delay return for mammography resolution (OR=2.62, p-value=0.017) compared to normal weight patients. Nulliparous patients were three times less likely to return for mammography resolution (OR=3.60, p-value=0.041). Conversely, patients with hysterectomies were five times more likely to return for timely mammography resolution (OR=5.44, p-value=0.007). Conclusion: The results of this study indicate that nulliparous, hysterectomized and obese women may exhibit important correlates of diagnostic mammography behavior. A thorough assessment of previous gynecologic history and pre-existing patient comorbidities linked to breast disease is necessary to evaluate a women's risk profile for breast cancer upon baseline screening mammography. Public health prevention programs are vital to identify incomplete mammography patients with a high risk profile for breast cancer combined with negative mammography screening beliefs. Tracking incomplete mammography patients until diagnostic follow-up is complete will prevent delayed treatment which has been associated with a 12% lower 5-year survival rate compared to prompt mammography resolution. Further clinical intervention is necessary in order to affect disparities in minority and medically underserved women's breast cancer survival.