Imaging centers and public health organizations may need to devote additional resources to provide access to follow-ups after a positive mammography, according to Louise Henderson, PhD, assistant professor at the University of South Carolina School of Medicine Department of Radiology.

Henderson was the senior author on a study published in Cancer, Epidemiology, Biomarkers & Prevention that found uninsured women younger than 65 years old had delayed follow-up appointments after a positive mammogram.

“If we’re going to use mammography to screen women for breast cancer, we need to make sure that women with a positive result receive the needed follow-up care, regardless of her insurance,” said Henderson in a press release.

Henderson’s research focuses on cancer screening and potential links between large amounts of patient data and care outcomes. Her team of researchers compiled patient data from more than 43,000 women who received breast screening in a North Carolina-based registry.

They found increased odds of uninsured women missing the follow-up within the CDC-recommended 60 days, and approximately 10 percent of women had no follow-up within a year. Some 18 percent of uninsured women under the age of 65 did not undergo a follow-up within 60 days, compared to 11 percent of insured women of the same age.

Delays in follow-ups are correlated with negative outcomes down the road, according to previous studies. Women who wait to schedule a follow-up appointment often start treatment later, resulting in larger tumors at treatment and higher mortality.

“We found there are women who aren’t getting follow-up after a positive screening mammogram, and we need to understand why so that we can determine what to do about it. It does seem to vary by insurance, based on some of the data that we present,” Henderson said.

One way to guide patients around barriers in the screening and treatment process is a patient navigation system. Pioneered in the early 1990s by Harold Freeman, MD, a patient navigation system aims to integrate fragmented healthcare systems. It’s been shown to increase the chances of disadvantaged women receiving appropriate follow-up care after an abnormal screening, improving follow-up by 15 percent.

“It’s important to remember that this is a particular population of people who have sought care,” said first author Danielle Durham, PhD, Cancer Prevention Fellow at the National Cancer Institute. “It would be interesting to see if these trends would be replicated in other populations in the United States.”