Research points way to prioritize patients for mammograms


Researchers have found a way for providers to prioritize which patients need mammograms the soonest based on a few simple questions about whether a woman has a lump or other potential symptoms of breast cancer, according to a new study.


Lead author Diana Miglioretti from the University of California Davis School of Medicine said she and other researchers wanted to help providers prioritize screenings during the pandemic, when patients are delaying care.


“We heard from different places that they were really struggling,” Miglioretti said. “(The) women that you should definitely get in are, women with breast symptoms, like a new lump.”


The investigation, published March 25 in the Journal of American Medical Association Network Open, found that patients who’d made mammogram appointments because of a breast lump or other symptom like nipple discharge were much more likely to have a cancer diagnosis. Patients who were coming in for the evaluation of an abnormal mammogram also were at higher risk of having a cancer diagnosis. Of the close to 900,000 individuals with mammograms between 2014 and 2019, 12% who reported one of these symptoms accounted for 55% of the total cancer diagnoses that were detected in the screenings.


Health providers now and in the future can look at information from the time an appointment is made, like whether they indicate a symptom, to triage those patients, according to Miglioretti. Especially during a period of reduced ability to see patients, the technique could result in detecting the most cancers while performing the fewest examinations compared with a non-risk-based approach. She said providers should usually already have information in records about why patients have mammogram appointments.


“When the individual calls to make the appointment, or you need to cancel appointments – say we get another surge and we need to shut down – it will say typically in their record why they’re there,” Miglioretti said. “When a woman schedules her appointment, you’ll see that, ‘I set an appointment, because I have a new lump in my left breast.'”


Patients who were the least at risk included women below the age of 69 coming in for their annual screening with no personal history of breast cancer, which accounted for 44% of the total screenings, and accounted for 13% of the total cancer diagnosis in the data.


Miglioretti said she only knows of one health provider who has a risk-based screening program, but it might be the most effective way to catch cancer early and help patients avoid chemotherapy and other treatments in the future.


The study used data collected prospectively from mammography examinations performed in a five-year time span 92 radiology facilities in the Breast Cancer Surveillance Consortium, and had a confidence interval of 95%. It was funded through a Patient-Centered Outcomes Research Institute program award, and the National Cancer Institute, the Agency for Healthcare Research and Quality and the Lake Champlain Cancer Research Organization.



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