VA medical center expands mammography, increases patient volume

When Baltimore Veterans Affairs (VA) Medical Center expanded its mammography screening program in 2008 to cater to a growing number of female veterans, the hope was that the interval from diagnosis to treatment would decrease. However, time to treatment actually grew longer with increased volumes in the post-intervention period.

A retrospective study of the mammography program, published online Sept. 18 in JAMA Surgery, also found increased utilization of non-VA breast care services, indicating VA hospitals will have to do more to absorb the growing volume of patients connected to screening mammography expansion.

“Our data suggest that as patient volumes increase with intensified screening, VA hospitals may benefit from acquiring a full complement of on-site breast care services rather than improving flow between VA hospitals and non-VA breast care centers having specialized resources,” wrote authors Charlotte L. Kvasnovsky, MD, from Baltimore VA Medical Center, and colleagues.

The study analyzed all breast cancer cases at Baltimore VA Medical Center from Jan. 1, 2000, through May 31, 2012, which included a total of 7,355 mammograms and 76 breast cancer patients receiving treatment.

Most of the mammograms (6,720) were performed after the 2008 expansion of breast care services, with a median 1,453 mammograms performed annually during this post-expansion period. This represented a 1,200 percent increase in mammography utilization compared with 2000-2007.

The growth in mammography use led to a 48 percent increase in the annual number of patients who received cancer treatment, reported the authors.

More than 86 percent of patients received screening and diagnostic imaging, biopsy and surgery between multiple institutions.

While the time from screening to tissue diagnosis remained steady at 34 days before and after the expansion, the time from tissue diagnosis to initiation of definitive treatment increased from 33 days to 51 days from 2008-2012.

Kvasnovsky and colleagues speculated that the increased time simply may reflect increased volumes from a successful expansion of screening services. With an increased need to utilize non-VA-based resources for advanced imaging and biopsy comes a potential for an increased time required to complete workup. Another possibility is that remote VA hospitals may have increased referrals to take advantage of the successful implementation of a breast care program.

The study also found that breast conservation therapy was received by more than two thirds of eligible patients, while 32.7 opted for mastectomy, though the authors noted that this was largely the result of patient preference or clinical/social factors.