Follow-up for abnormal mammograms more successful over the phone

Communicating verbally—whether that’s over the phone, in person or through voicemail—is the best way to achieve timely follow-up with breast imaging patients whose mammograms are inconclusive, according to a study published ahead of print in Academic Radiology.

The research, led by first author and University of Pennsylvania Medical Center professor Marilyn M. Schapira, MD, MPH, found verbal follow-up superior to email, snail mail and EMR-generated reminders in reaching out to patients whose mammograms were assigned a BI-RADS score of 0.

“Progression through the screening process, from initial screening through follow-up of abnormal results to treatment, can fail at multiple points in the screening episode,” Schapira et al. wrote. “Lack of effective communication between facilities, providers and patients may delay follow-up and lead to adverse health outcomes, including anxiety, delay in diagnosis and widening of cancer outcome disparities.”

The authors collected information about screening mammogram follow-up through a survey distributed between 2011 and 2014 and evaluated the data the following year. For the purposes of the study they considered timely follow-up of BI-RADS 0 results to be within 15 days of the mammogram, though the Mammography Quality Standards Act mandates communication within 30 days. The FDA, on the other hand, has in the past made it clear “that communication of suspicious or highly suggestive results can ordinarily be accomplished within five working days.”

The eventual analysis included 34,680 mammography examinations across 28 facilities, Schapira and her team said. Over 85 percent of exams had a follow-up within 15 days.

“In a multilevel analysis, we evaluated facility-level standard practices regarding modes of communication routinely used when additional imaging is recommended or the patient misses her appointment for additional imaging,” the authors wrote. “For both scenarios, verbal communication by phone was associated with timely follow-up.”

Oppositely, they said, written communication through the EMR was negatively associated with timely follow-up, as was standard paper mail. Facilities were more likely to achieve timely follow-up with written contact if they mailed out reminder letters routinely after a patient missed her visit.

Schapira and co-authors said written communication has its limitations.

“Mammography reports may not be written using principles of clear communication and plain language, and patients whose primary language is other than English face an additional barrier to understanding the mammography report,” they said, noting even EMR-generated reminders might not be helpful since physicians are often too overloaded to act on them.

Improved verbal communication also poses some barriers, the authors said, like carving out the time and space for consultations, training staff in communication and practicing batch reading, but their study found it could be more successful than traditional mailing techniques.

“Our findings support the value of telephone communication to patients,” they wrote. “Future research is needed to evaluate the role of communication in completing the breast cancer screening episode.”