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Posted: June 14th, 2020

Improving Follow-Up After Abnormal Cancer Screening Tests

Improving Follow-Up After Abnormal Cancer Screening Tests

Cancer screening tests are important tools for detecting cancer at an early stage, when it is more likely to be treatable and curable. However, screening tests are not perfect, and sometimes they can show abnormal results that are not due to cancer. These false-positive results can cause anxiety, stress, and unnecessary follow-up tests and treatments for patients.

According to a recent study by the American Cancer Society, about 12% of women who undergo mammography and 13% of men who undergo prostate-specific antigen (PSA) testing have abnormal results that are not confirmed as cancer after further evaluation. The study also found that many patients who have abnormal results do not receive timely and appropriate follow-up care, which can lead to missed or delayed diagnosis of cancer.

The reasons for the lack of follow-up care are complex and multifactorial, involving patient, provider, and health system factors. Some of the barriers that patients face include:

– Lack of awareness or understanding of the need for follow-up
– Fear of finding out bad news or undergoing invasive procedures
– Cost or lack of insurance coverage for follow-up tests
– Difficulty accessing care or scheduling appointments
– Low health literacy or language barriers
– Competing priorities or personal issues

Some of the barriers that providers face include:

– Unclear or inconsistent guidelines for follow-up
– Lack of communication or coordination among different providers
– Heavy workload or time constraints
– Limited resources or equipment for follow-up tests
– Lack of feedback or quality improvement measures

Some of the barriers that health systems face include:

– Fragmented or siloed care delivery
– Inadequate or incompatible electronic health records
– Lack of standardized protocols or policies for follow-up
– Lack of incentives or accountability for follow-up care

To address these challenges and improve follow-up care after abnormal cancer screening tests, several strategies have been proposed and tested by researchers and practitioners. Some of the effective interventions include:

– Patient education and counseling: Providing clear and accurate information about the meaning and implications of abnormal results, the benefits and risks of follow-up tests, and the steps and timeline for follow-up care can help patients make informed decisions and reduce their anxiety and uncertainty.
– Patient navigation: Assigning a trained person, such as a nurse, a social worker, or a community health worker, to guide patients through the follow-up process can help them overcome barriers, such as scheduling appointments, arranging transportation, obtaining referrals, and accessing financial assistance.
– Provider reminders and feedback: Sending alerts or notifications to providers when their patients have abnormal results or when they are due for follow-up tests can help them keep track of their patients’ status and ensure timely and appropriate care. Providing feedback on their performance or comparing them with their peers can also motivate them to improve their follow-up rates.
– System-level changes: Implementing changes in the organization or delivery of care, such as creating multidisciplinary teams, streamlining referral processes, integrating electronic health records, standardizing protocols, and providing incentives or penalties for follow-up care can enhance the quality and efficiency of follow-up services.

Improving follow-up care after abnormal cancer screening tests is crucial for preventing missed or delayed diagnosis of cancer and improving patient outcomes. By applying these evidence-based strategies, patients, providers, and health systems can work together to ensure that every patient receives the best possible care.


: Smith RA, Andrews KS, Brooks D, et al. Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2019;69(3):184-210. doi:10.3322/caac.21557

: Allen JD, Bluethmann SM, Sheets M, et al. Women’s responses to changes in U.S. Preventive Task Force’s mammography screening guidelines: results of focus groups with ethnically diverse women. BMC Public Health. 2013;13:1169. doi:10.1186/1471-2458-13-1169

: Percac-Lima S, Ashburner JM, Bond B, et al. Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial. Cancer Med. 2019;8(1):59-68. doi:10.1002/cam4.1880

: Sequist TD, Zaslavsky AM, Marshall R, Fletcher RH, Ayanian JZ. Patient and physician reminders to promote colorectal cancer screening i need help writing a dissertation: a randomized controlled trial. Arch Intern Med. 2009;169(4):364-371. doi:10.1001/archinternmed.2008.564

: Taplin SH, Haggstrom D, Jacobs T, et al. Implementing colorectal cancer screening in community health centers: addressing cancer health disparities through a regional cancer collaborative. Med Care. 2008;46(9 Suppl 1):S74-S83. doi:10.1097/MLR.0b013e31817fdf6a


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