Advancing Breast Cancer Screening Equity in a Large Safety Net Health System: Development of a System-Wide Registry

Purpose: Access to breast cancer screening leads to earlier malignancy detection and helps mitigate adverse outcomes. The American College of Radiology recommends annual screening mammography for all women over 40 and BI-RADS provides a framework to guide follow-up evaluations and imaging. Timely screening and follow up are critical for early breast cancer detection; however, barriers to receiving appropriate follow-up can lead to delayed diagnoses, increased mortality and greater burden on the healthcare system. Our system is the largest municipal safety net health system in the country, with 11 acute care hospitals and 9 outpatient offices performing breast imaging. Recent national data identifying racial disparities in breast cancer outcomes is of particular concern as we serve a population that is 80% Black/Latinx. Our initiative was to develop a Breast Cancer Screening Registry to better evaluate adherence to screening throughout our system and to highlight process gaps that can be targeted for quality improvement.

Methods/Materials: The Breast Cancer Screening Registry was developed through collaboration with Ambulatory Care, Population Health, Breast Radiology, and Breast Surgery. Inclusion criteria include: Female Sex, Age 40 – 74 and Engaged in OBGYN or Primary Care. Initial parameters evaluated include: Screening Rates, Active and Scheduled Mammogram Order for Overdue Patients, and Adherence to BIRADS 0, 3, 4 and 5 Follow-up.

Results: The Breast Cancer Screening Registry is being utilized to identify opportunities for improving system workflows with the goal of optimizing engagement in screening and ensuring timely follow-up care. Initial improvement opportunities identified include optimizing procedure scheduling, standardizing workflows for follow up across our multiple sites, and aligning preventive care with current screening guidelines.

Conclusions: Development of a Breast Cancer Screening Registry allows for real-time, accurate assessment of adherence to screening and follow up recommendations throughout the health system. As we continue to address specific process gaps, the registry will be utilized as a quantitative feedback mechanism to assess the effectiveness of specific initiatives.