ABSTRACT
Background: Screening mammography programs often require patients undergo multiple visits (screening exam, diagnostic exam, and biopsy) before tissue diagnoisis of screen-detected abnormalities. During the COVID-19 pandemic, same-day breast imaging services were leveraged to decrease the number of visits following abnormal screening exams. Specifically, in May 2020, we implemented an immediate-read screening mammography program to synergize with our pre-existing same-day breast biopsy program, such that every effort was made to perform diagnostic imaging during the same visit after an abnormal screening mammogram. This study aims to evaluate the impact of these same-day breast imaging services on time and number of patient visits to undergo breast biopsy after an abnormal screening mammogram. Methods: Consecutive screening mammograms performed during normal business hours pre- (6/1/16 to 5/30/17) and post-implementation (6/1/20 to 5/30/21) of same-day services were identified. Patient demographics, imaging and biopsy results, and visit dates were extracted from the medical record. Multivariable logistic, linear, and ordinal regression models estimated with generalized estimating equations were fit to assess the association of period (pre- versus post-implementation), patient age, and race and ethnicity (White versus races other than White) with having a same-day biopsy (biopsy on the same day as the abnormal screening exam), number of days to biopsy, and number of visits. Adjusted odds ratios (aOR) and beta estimates (aBeta) of each covariate and corresponding 95% confidence intervals (CI) were estimated. Results: A total of 409/25,922 (1.6%) of patients (median age 61, IQR 50-70) pre-implementation and 221/20,452 (1.1%) patients (median age 62, IQR 49-71) post-implementation had screen-detected abnormalities leading to diagnostic breast imaging and biopsy. Median number of days from screening to biopsy decreased from 16 days pre-implementation to 5 days post-implementation (p < 0.001). Pre-implementation, 86.8% of patients required 3 visits between screening and biopsy, while post-implementation only 23.1% required 3 visits (p < 0.001). Compared to pre-implementation, the post-implementation period was associated with increased odds of undergoing same-day biopsy (aOR 20.7, 95% CI 8.3-51.7), p < 0.001), fewer days from abnormal screening mammogram to biopsy (aBeta -13.3, 95% CI -15.7 to -10.9, p < 0.001), and fewer visits (aOR 0.05, 95% CI 0.02-0.09), p < 0.001), controlling for age and race and ethnicity. Conclusions: Same-day breast imaging services decreased time and patient visits between abnormal screening mammogram and breast biopsy. Same-day services implemented out of necessity during the COVID-19 pandemic should be continued after the pandemic has subsided to improve timeliness of care.
ABSTRACT
Background: During the COVID-19 pandemic, barriers to access screening mammography along with goals to reduce visits supported immediate reading of screening mammograms. Typically, screening mammograms are reported after patients have left the facility. If imaging is abnormal, then an additional visit is needed for diagnostic imaging, introducing delays and potential disparities.Thus, we implemented an immediate-read screening mammography program and measured its impact on racial/ethnic disparities in time to diagnostic imaging after an abnormal screening mammogram. Methods: Responding to the COVID-19 pandemic, we implemented an immediate read screening program in late May 2020. Patients were provided imaging results before discharge and if the exam was abnormal, efforts were made to perform diagnostic imaging during that visit. We identified consecutive screening mammograms performed weekdays 8:00am-4:30pm and Saturdays 9:00am-4:00pm pre-implementation (6/1/19-10/31/19) and post-implementation (6/1/2020-10/31/2020). Exams left unread while awaiting comparison studies, due to technical factors, or for more than 10 days were excluded. Patient demographics and time from screening exam completion to report finalized were obtained from the electronic medical record. Cancer detection rate (CDR), abnormal interpretation rate (AIR), and positive predictive value (PPV) were calculated. Multivariable linear and logistic regression models were used to compare time from screening exam to report, same-day diagnostic imaging, and screening performance metrics pre- and postimplementation overall and by patient subgroups. Results: After 963 exams met exclusion criteria, a total of 8,222 pre- and 7,235 post-implementation exams were included. Median time to report finalization decreased from 61minutes (interquartile range [IQR]:24, 152) to 4 minutes (IQR:2, 7) for pre- and postimplementation periods (p < 0.001). During the pre-implementation period, non-white patients had lower odds of having same-day diagnostic imaging after an abnormal screening exam (age-adjusted odds ratio: 0.28;95% CI: 0.10, 0.78 p = 0.015). There was no evidence of this disparity post-implementation. AIR was higher in the pre- versus post-implementation period (6.3% versus 5.0%;p < 0.001). There was no evidence of a difference in CDR (5.8 versus 4.2 cancers/1,000 exams) and PPV (9.2% versus 8.4%) for pre- versus post-implementation periods. Conclusions: An immediate read screening mammography program reduces racial/ethnic disparities in time to diagnostic imaging after an abnormal screening mammogram, thus promoting equity in access to care. (Table Presented).