{"doi":"10.1007/s11606-022-07657-4","title":"Extent of Follow-Up on Abnormal Cancer Screening in Multiple California Public Hospital Systems: A Retrospective Review","abstract":"BACKGROUND: Inequitable follow-up of abnormal cancer screening tests may contribute to racial/ethnic disparities in colon and breast cancer outcomes. However, few multi-site studies have examined follow-up of abnormal cancer screening tests and it is unknown if racial/ethnic disparities exist. OBJECTIVE: This report describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems. DESIGN: We conducted a retrospective cohort study using data from five California public hospital systems. We used multivariable robust Poisson regression analyses to examine whether patient-level factors or site predicted receipt of follow-up test. MAIN MEASURES: Using data from five public hospital systems between July 2015 and June 2017, we assessed follow-up of two screening results: (1) colonoscopy after positive fecal immunochemical tests (FIT) and (2) tissue biopsy within 21 days after a BIRADS 4/5 mammogram. KEY RESULTS: Of 4132 abnormal FITs, 1736 (42%) received a follow-up colonoscopy. Older age, Medicaid insurance, lack of insurance, English language, and site were negatively associated with follow-up colonoscopy, while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 1082 (64%) received a timely biopsy; only site was associated with timely follow-up biopsy. CONCLUSION: Despite the vulnerabilities of public-hospital-system patients, follow-up of abnormal cancer screening tests occurs at rates similar to that of patients in other healthcare settings, with colon cancer screening test follow-up occurring at lower rates than follow-up of breast cancer screening tests. Site-level factors have larger, more consistent impact on follow-up rates than patient sociodemographic traits. Resources are needed to identify health system-level factors, such as test follow-up processes or data infrastructure, that improve abnormal cancer screening test follow-up so that effective health system-level interventions can be evaluated and disseminated.","journal":"Journal of General Internal Medicine","year":2022,"id":280431,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":10,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9603,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":353548,"name":"Natalie A. Rivadeneira","orcid":"0000-0003-2421-9915","position":1,"is_corresponding":false},{"id":954864,"name":"Lucia Pacca","orcid":"0009-0009-0154-4425","position":2,"is_corresponding":false},{"id":237756,"name":"Dean Schillinger","orcid":"0000-0002-7221-7327","position":3,"is_corresponding":false},{"id":955358,"name":"David Lown","orcid":null,"position":4,"is_corresponding":false},{"id":955359,"name":"Palav Babaria","orcid":null,"position":5,"is_corresponding":false},{"id":416558,"name":"Neha Gupta","orcid":"0000-0001-8181-7378","position":6,"is_corresponding":false},{"id":809106,"name":"Rajiv Pramanik","orcid":"0000-0002-0601-4767","position":7,"is_corresponding":false},{"id":954865,"name":"Helen Tran","orcid":"0009-0007-6053-6703","position":8,"is_corresponding":false},{"id":955360,"name":"Tyler Whitezell","orcid":null,"position":9,"is_corresponding":false},{"id":228706,"name":"Ma Somsouk","orcid":"0000-0001-6116-3645","position":10,"is_corresponding":false},{"id":353553,"name":"Urmimala Sarkar","orcid":"0000-0003-4213-4405","position":11,"is_corresponding":false},{"id":356244,"name":"Elaine C. Khoong","orcid":"0000-0002-2514-3572","position":0,"is_corresponding":true}],"reference_count":40,"raw_metadata":null,"created_at":"2026-07-19T00:29:03.247347Z","pmid":"35641722","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}