| Screening mammography's effectiveness may be reduced if women do not receive timely diagnostic follow-up after a positive mammogram. Lack of insurance may pose challenges to adequate follow-up. The objectives of this study were 1) to describe clinical follow-up after a positive screening mammogram, 2) to assess the association between insurance status and time to initial diagnostic follow-up after a positive screening mammogram, and 3) to assess the association between insurance status and receipt of biopsy. With data from a North Carolina population-based registry of breast imaging and cancer outcomes between 1995-2010, we used Cox proportional hazards regression modeling and multivariate logistic modeling to evaluate the association between insurance status and follow-up. The most common diagnostic resolution pathways following a positive screening mammogram were: 1) diagnostic mammography only (72%); 2) diagnostic mammography, ultrasound (11%); and 3) diagnostic mammography, biopsy (7%). In the adjusted model for women <65 years, uninsured women experienced a longer time to initiation of diagnostic follow-up (hazard ratio (HR) =0.47 (95% confidence interval (95% CI)) =0.25-0.89) versus women with private insurance. There was an increased odds of these uninsured women not meeting the CDC guideline for follow-up within 60 days (1.59, 95% CI (1.31-1.94). Women under 65 with Medicare & Medicaid were more likely to have experienced a pathway including biopsy (OR 1.68, 95% CI 1.05-2.68) when compared to those with private insurance. Among women ages 65+, women with private insurance alone experienced a faster time to follow-up (adjusted HR=2.09, 95% CI=1.27-3.44) compared to women with Medicare combined with private insurance. Approximately 10% of women had no follow-up by 365 days. Women over 65 with private insurance were less likely to have experienced a pathway including biopsy when compared to those with Medicare and private insurance (OR 0.53, 95% CI 0.35-0.79). |
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