Researchers affiliated with Harvard University and the National Breast and Cervical Cancer Early Detection Program (BCCEDP) have reported that there is a significant delay in follow-up diagnostic tests and treatment following a positive mammogram in one-third of low-income women participating in this program. The details of this study were published early online in the Archives of Internal Medicine on March 16, 2010.[1]

The general consensus is that screening mammography decreases deaths from breast cancer. The general recommendation is that women 40 years or older have a screening mammogram every one to two years. However, there are still populations of women who do not undergo routine screening mammography, and it is important to identify these populations. Several factors influence compliance with these screening recommendations, including income and education. The BCCEDP program was started in 1990 to improve cancer screening in low-income women.

One of the key issues in improving screening for low-income women is to assure that appropriate follow-up is carried out when a test is positive. The current study involved 2,252 BCCEDP participants in Massachusetts between 1998 and 2007. In 2001 they instituted a case management program to improve follow-up of women with positive mammograms. Diagnostic delays were defined as those taking longer than 60 days. Treatment delays were defined as those taking longer than 90 days. These authors made the following observations:

• Before initiation of the case management program, diagnostic delays occurred in 33% of patients compared with 23% after initiation.
• After initiation of the case management program, there was no improvement in treatment delay.
• Free treatment did not reduce diagnostic or treatment delays.

These authors concluded: “Case management to assist women in overcoming logistic and psychological barriers to care may improve time to diagnosis among low-income women who receive free breast cancer screening and diagnostic services. Programs that provide services to coordinate care, in addition to free screening and diagnostic tests, may improve population health.”

Comments: This study emphasizes the difficulty of improving cancer screening and treatment among low-income women.

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