摘要：Objectives. To determine the effects of program policy changes, we examined service delivery benchmarks for breast cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Methods. We analyzed NBCCEDP data for women with abnormal mammogram or clinical breast examination (n = 382 416) from which 23 701 cancers were diagnosed. We examined time to diagnosis and treatment for 2 time periods: 1996 to 2000 and 2001 to 2005. We compared median time for diagnostic, treatment initiation, and total intervals with the Kruskal–Wallis test. We calculated adjusted proportions (predicted marginals) with logistic regression to examine diagnosis and treatment within program benchmarks (≤ 60 days) and time from screening to treatment (≤ 120 days). Results. Median diagnostic intervals decreased by 2 days (25 vs 23; P < .001). Median treatment initiation intervals increased by 2 days (12 vs 14; P < .001). Total intervals decreased by 3 days (43 vs 40; P < .001). Women meeting the 60-day benchmark for diagnosis improved the most for women with normal mammograms and abnormal clinical breast examinations from 77% to 82%. Conclusions. Women screened by the NBCCEDP received diagnostic follow-up and initiated treatment within preestablished program guidelines. Screening for breast cancer reduces morbidity and mortality from breast cancer when women receive timely follow-up and appropriate treatment. 1 There are few data to indicate what the optimal diagnostic and treatment intervals are that might ensure the best chances of survival from breast cancer detected by screening with mammography. 2 , 3 Recent information from organized screening programs in Canada and the United Kingdom showed that women who waited longer than 6 to 12 months for diagnostic workup were more likely to have larger cancers and more positive lymph nodes, which might lead to poorer survival. 2 , 3 In the case of symptomatic women, delays greater than 3 to 6 months to start therapy are associated with poorer survival. 4 Recent modeling studies have shown that the declines in mortality are attributable to both early detection and subsequent treatment. 1 Minority women, uninsured women, and women from lower socioeconomic backgrounds often do not have access to early detection. 5 – 7 These women are less likely to participate in mammography screening, 8 less likely to have timely and complete follow-up after an abnormal screening test result, 9 , 10 more likely to be diagnosed with late-stage breast cancer, 6 , 7 , 11 more likely to die from breast cancer once diagnosed, 6 , 7 and might be more likely to receive suboptimal treatment. 12 – 15 The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was authorized by Congress in 1990 to reach underserved women. 16 Since the inception of the program, the NBCCEDP has established service delivery benchmarks to ensure timely and complete diagnostic follow-up and treatment initiation for underserved women screened through the program. 17 Previous analysis of program benchmarks demonstrated that the national program was meeting its predefined quality standards of having a diagnosis within 60 days of an abnormal screening test result and initiation of treatment within 60 days of diagnosis. 18 Legislation for program enhancements that added case management services, which was fully implemented in 2000, and a Medicaid waiver authorized by Congress in 2000 and fully implemented in 2003, should have improved the program's ability to meet these standards. 19 – 22 Accordingly, we hypothesized that NBCCEDP service delivery benchmarks would improve over time with shortening of time intervals after an abnormal mammogram or clinical breast examination (CBE) finding to final diagnosis, as well as the interval to treatment initiation after diagnosis, and the interval to treatment initiation after abnormal screening test result. We investigated this by using 2 time periods, 1996 to 2000 and 2001 to 2005, 20 to examine the effects of program policy changes on intervals in the 2001–2005 period. 20 – 22
