Factors that influence follow-up after an abnormal mammogram

Abstract

The focus of this study was to explore women’s experiences with follow-up after an abnormal mammogram, and factors that influence follow-up. Factors, including health status, found in the cancer screening and treatment literature, are necessary in identifying variables which have the potential to affect a person’s perception, and promote or deter follow-up. Protection Motivation Theory constructs utilized in this study are found in the literature to improve diagnostic health behaviors such as performing breast self-examination and complying with diagnostic tests. A non-experimental, descriptive, cross-sectional design was used to identify the barriers to follow-up after an abnormal mammogram by: 1) determining the noncompliance rate of follow-up mammograms among women screened at an urban hospital’s mammography mobile unit in North Texas (October 1, 2004, to September 31, 2005) who were found to need further evaluation for suspected abnormal findings; and 2) identifying factors associated with noncompliance and perceived barriers to noncompliance. The sample consisted of 262 participants, 136 (52%) women whom the hospital reported had not returned for follow-up and 126 (48%) women who were reported to have returned. A logistic regression model was performed using follow-up as the dependent variable. The variables most related to follow-up were (1) number of mammograms in the last 5 years; (2) having health insurance; (3) having problems receiving abnormal mammogram results; (4) having problems receiving or making a follow-up appointment; (5) taking off from work for the follow-up appointment; (6) not having transportation to follow-up appointment; and (7) waiting a long time to receive the follow-up appointment. Non-compliance to recommended follow-up after an abnormal mammogram is a serious public health concern, since breast cancer screening can improve breast cancer outcomes only if prompt diagnostic resolution and access to state-of-the-art care is available to all screening participants. This study adds to the literature on predictors of follow-up after an abnormal mammogram, as well as the to the health disparities literature.