Cancer history, costs inhibit follow-up compliance among BI-RADS 3 patients

There is no shortage of research investigating the effectiveness of the Breast Imaging Reporting and Data System (BI-RADS) category 3 in mammography, but what’s less understood is why some women complete follow-up recommendations while many do not.

A BI-RADS 3 designation indicates there is between a 0% and 2% chance of cancer, for which physicians recommend six-month follow-up. Authors of an Oct. 8 study published in the Journal of the American College of Radiology found while a majority of patients completed follow-up, only slightly more than half did so in the appropriate time frame.

The team from Johns Hopkins in Baltimore set out to understand why.

“There is currently a gap in knowledge regarding what factors predict patients’ compliance with recommended breast MRI short-term follow-up examinations,” Russell H. Morgan, with Johns Hopkins Department of Radiology and Radiological Science, and colleagues wrote. “Although studies have shown low compliance with the recommendation for short-term imaging follow-up, it is critical to understand what factors determine compliance to address barriers for our patients.”

Morgan and colleagues retrospectively analyzed 190 women given a BI-RADS 3 category following an MRI performed between February 2011 and June 2016. Demographics and patients' breast-related medical history were taken from the electronic medical record and included in the study. Women who received a follow-up MRI between three and 10 months were deemed compliant.

In total, 106 women were compliant with follow-up MRI recommendations, 34 delayed their MRI and 45 were noncompliant.

Zero of the sociodemographic factors the researchers analyzed (race, marital status, employment status, and living situation) were “significantly” associated with compliance. Noncompliant patients did tend to have higher out-of-pocket expenses (mean of $352) compared to the complaint group ($83) and those who delayed follow-up ($20).

Patients with a personal history of breast cancer and family history of the disease were associated with greater compliance, the researchers found. This could be due to a higher “perceived risk of cancer,” and the fact that these specific patients are often followed by a breast cancer specialist for years post-diagnosis.

More research is needed to confirm these findings, the researchers explained, and to formulate plans to address gaps in compliance.

“Our data suggest that there may be subsets of patients who would benefit from additional support and resources to help increase their likelihood to follow through with recommended short-interval follow-up,” the authors concluded. “Future steps include identifying techniques that could be used to increase compliance, such as improving communication or reminder systems.”