Innovative Inpatient Mammograms Can Diminish Breast Cancer Screening Disparities

A pilot study intervention successfully provides mammograms for patients who face screening challenges.

Offering mammograms to inpatients could be a good way to screen women who might otherwise face challenges in getting imaged.

For many women, mammograms fall by the wayside either because they do not have transportation to the clinic or they cannot get time off work. To address this problem, investigators from Massachusetts General Hospital (MGH) tested an inpatient-mammogram intervention to see if it could be an easier way to tackle preventive care needs.

“We designed the study to reach the patients who face significant barriers to completing their mammograms in the outpatient setting,” said first author Andrew S. Hwang, M.D., MPH, and MGH internist.

Hwang’s team published their results in the January issue of Annals of Family Medicine.

Breast cancer screening rates are particularly low among Medicaid and dual-eligible patients, according to existing national and local data. If this intervention is successful, he said, it could help reduce disparities by simultaneously addressing patients’ acute and preventive care needs.

To test their intervention, Hwang’s team pinpointed women who were Medicaid and dual-eligible, had been admitted to MGH’s general medicine service between March 2019 and March 2020, and who were overdue for a mammogram. These inpatients also had a primary care provider associated with MGH with whom they could follow up for any abnormal results.

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Overall, the team identified 21 women who met these criteria, and 17 went through with the inpatient mammogram – four were discharged before the screenings could be scheduled. For 35 percent of the screened group, this was their first mammogram – the remaining patients were overdue for a scan by an average of four years. All but one mammogram was negative, and providers recommended that patient pursue additional imaging to rule out cancer.

It is important to note, Hwang said, that scheduling a mammogram during the inpatient stay did not extend the patient’s hospitalization. Consequently, he and his team would like to extend the intervention to patients who are admitted into other areas of the hospital, as well as expand it to include other preventive services for low-income men and women, such as fecal immunochemical tests for colorectal cancer screening. Such innovative measures will be vital to addressing patients’ psychosocial needs and breaking down the barriers to care that many of them experience.

“[As] our healthcare system transitions from fee-for-service to value-based payment models, improving health outcomes among underserved patient populations will become increasingly important,” he said. “Completing preventive screening tests, such as mammograms, during hospitalizations can be one way to help patients who might otherwise miss preventive care.”