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Adults with diabetes residing in "food swamps" have higher hospitalization rates

Objective: To investigate mammography facilities’ followup times, population vulnerability, systembased processes, and association with cancer stage at diagnosis.

Data Sources: Prospectively collected from San Francisco Mammography Registry (SFMR) 20052011, California Cancer Registry 20052012, SFMR facility survey 2012.

Study Design: We examined time to biopsy for 17 750 abnormal mammogram results (BIRADS 4/5), categorizing eight facilities as short or long followup based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advancedstage (≥IIb) cancer diagnosis by facility followup group.

Data Extraction Methods: Merged SFMR, Cancer Registry and facility survey data.

Principal Findings: Facilities (N = 4) with short followup completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long followup (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long followup facilities. The long followup facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long followup facility was associated with higher adjusted odds of advancedstage cancer (OR 1.45; 95% CI 1.101.91).

Conclusions: Providing mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram followup and cancer diagnosis stage.

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