Disparities Associated With Patient Adherence of Post-Breast-Conserving Surgery Surveillance Imaging Protocols

Objective: Currently, national and international breast imaging practices utilize variable postsurgical surveillance protocols without uniform recommendations. Because of the innate differences between screening versus diagnostic mammography from scheduling flexibility to out-of-pocket costs, this creates the opportunity for lapses in patient adherence, which has the potential to impact clinical outcomes. The purpose of this study is to evaluate the relationship between sociodemographic factors and postsurgical surveillance imaging protocols on patient adherence rates. Methods: This retrospective study reviewed 3 years of surveillance imaging for all patients having breast-conserving surgery at our institution from January 2011 to December 2016. Follow-up adherence was defined as returning for all of the first 3 years of annual follow-up after breast-conserving surgery (institutional surveillance protocol). Associations between adherence to surveillance imaging and patient sociodemographic characteristics were evaluated using univariate and multivariate logistic regression. Results: The study included 1,082 patients after breast surgery, 715 of whom adhered completely to the first 3 years of annual follow-up (66.1%). Black women were 1.36 times less likely to follow up annually compared with White women (95% confidence interval 1.02-1.80). Similarly, patients with Medicare were 1.84 times less likely to follow up annually compared with patients with private insurance (95% confidence interval 1.34-2.51). Women with benign breast disease after breast-conserving surgery were significantly less likely to adhere to annual surveillance than women with breast cancer. Conclusion: Sociodemographic disparities exist as barriers for annual mammography surveillance in patients after breast-conserving surgery.