Study Looks at Contributing Factors to Incomplete Follow-Up for BI-RADS 3 Findings

Only 55 percent of Asian women have breast imaging follow-up after an initial Breast Imaging-Reporting and Data System (BI-RADS) 3 category diagnosis.

When follow-up imaging orders are issued by the breast oncology/breast surgery department, only 35 percent of patients with an initial BI-RADS 3 assessment complete the follow-up imaging.

Over half of the women with a BI-RADS 3 diagnosis on an initial ultrasound breast exam did not have follow-up breast imaging.

These are some of the findings from a new study examining a variety of factors that contribute to incomplete follow-up after initial BI-RADS 3 assessments. For the study, recently published in the Journal of the American College of Radiology, researchers reviewed data from 3,104 cases of initial BI-RADS 3 assessments and noted incomplete follow-up (after 15 months of the study examination) in 543 cases (17.5 percent).

In order to assess the impact of social determinants upon follow-up of initial BI-RADS 3 findings, the study authors utilized the area deprivation index (ADI), which incorporates 17 United States census-based measures related to education, housing, employment, and poverty as well as American Community Survey data. The researchers found that 30 percent of women living in the highest disadvantaged neighborhoods had incomplete follow-up imaging after a BI-RADS 3 diagnosis.

“For health systems, radiology departments and health providers seeking to improve patient timely follow-up of breast imaging examinations with BI-RADS 3 findings, ADI may be a more important measure for identifying at-risk patients than individual patient factors such as race, ethnicity, or language,” wrote lead study author Catherine S. Giess, M.D., an associate professor of radiology at Harvard Medical School and deputy chair of the Department of Radiology at Brigham and Women’s Hospital in Boston, and colleagues.

(Editor’s note: For related content, see “Can MRI Provide Greater Clarity of Suspected BI-RADS 3 Lesions?” and “What BI-RADS Changes Are on the Way for Breast MRI Reporting?”)

Noting rising rates of breast cancer in Asian women, the study authors said the multivariable analysis findings of incomplete follow-up imaging (45 percent) and greater than one-month delays with orders for follow-up imaging (35 percent) in this population is particularly troubling.

“Our finding that Asian women are less likely to undergo BI-RADS 3 follow-up and are less likely to have timely order placement for follow-up imaging is concerning,” maintained Giess and colleagues. “ … Disparate outcomes in breast cancer for Asians versus non-Asian women in the United States are multifactorial and include cultural and biological factors as well as screening access. It is unclear in our study why Asian race is associated with delayed ordering of follow-up imaging, but this warrants further study to understand the underpinnings of this disparity.”

The researchers also found associations between timely ordering of follow-up imaging and the departments issuing the orders. In contrast to a 90 percent odds ratio (OR) for a non-breast radiology department ordering BI-RADS 3 follow-up imaging within one month after initial examination, the study authors noted a 40 percent OR for the breast oncology/breast surgery department and a 9 percent OR for primary care providers.

“Our health system has both centralized (breast imaging and central radiology scheduling) and decentralized (physician offices) pathways in which follow-up imaging may be ordered, and our results demonstrate a significant difference in timely order placement and scheduling when radiology transcribes the order and schedules the exams compared to non-radiology offices,” noted Giess and colleagues.