Follow-up after an abnormal screening mammogram: Impact of a pandemic on mobile mammography patients.

Abstract

Objectives: To evaluate the effect of COVID-19 on a mobile screening mammography program as measured by turnaround time (TAT) in days between an abnormal screening mammogram (sMG) and diagnostic mammography.

Material and methods: All of our institution's sMG (mobile and non-mobile) from January 2017, to December 2022 were retrospectively reviewed, and those dated March 7, 2020-July 7, 2020 were excluded because our mobile sMG program was non-operative at that time due to COVID-19. TATs and patient demographics were compared for mobile and non-mobile sMG patients between 2 time periods: Pre-pandemic (January 1, 2017-March 6, 2020) and pandemic (July 8, 2020-December 31, 2022). Statistics included multiple linear regression analysis, Fisher's Exact, and Wilcoxon Rank Sum tests.

Results: During the pre-pandemic period, 11,439 female patients (9309 without insurance, 81.3%) underwent 14,161 mobile sMG, while 28,737 female patients (429 without insurance, 1.5%) underwent 57,840 non-mobile sMG. During the pandemic period, 6805 female patients (6720 without insurance, 98.8%) underwent 7663 mobile sMG, while 32,655 female patients (868 without insurance, 2.7%) underwent 53,540 non-mobile sMG. Median TATs for mobile uninsured patients increased from 41 days during the pre-pandemic period to 51 days during the pandemic period (p < 0.001), while median TATs for non-mobile insured patients decreased from 20 days during the pre-pandemic period to 14 days during the pandemic period (p < 0.001). Increased TATs were associated with Asian, African American, and Other race compared with White race (Asian, p = 0.004; African American, p < 0.001; and Other, p = 0.02) and self-pay insurance status (p = 0.006).

Conclusion: For mobile uninsured screening patients, the number of days between screening and diagnostic mammography increased with the COVID-19 pandemic, while it decreased for non-mobile insured screening patients. Mobile uninsured mammography patients may represent a population that needs additional attention. These findings highlight a health equity concern, as the pandemic disproportionately widened disparities in timely follow-up care for uninsured patients served by mobile mammography programs.