The interviews revealed that participants’ experiences related to follow-up and diagnosis depended on communication processes. About one-third of participants experienced a follow-up delay of 30 days or more between mammogram and biopsy.

“We identified poor health-system communication as the primary source of difficulty for women receiving information about an abnormal mammogram and needing to undergo further testing, particularly biopsy,” said study author Leah Karliner, MD, MAS, director for the Center for Aging in Diverse Communities and the Multiethnic Health Equity Research Center at University of California San Francisco (UCSF).

Some effective strategies of communication identified included direct verbal communications with the ability to ask questions, the explanation of medical processes and terminology avoiding jargon, and the use of interpretation services for women with limited English proficiency.

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“This study is important because the investigators did not pre-suppose that they understood why patients can experience delays in following up abnormal mammograms,” said Urmimala Sarkar, MD, MPH, professor of medicine at UCSF and associate director of the UCSF Center for Vulnerable Populations. “Qualitative studies like this can pinpoint previously unknown barriers to delivery of high-quality care.”

Additionally, these findings are applicable to follow-up of all kinds of medical test results, said Dr Sarkar, who was not involved in the study.

For mammograms, Dr Sarkar noted, this study demonstrates that in order to ensure women who have abnormal mammograms have proper follow-up, health systems should reach out to patients verbally — in person or via telephone. This communication should be done in a way that allows patients to ask questions, with the use of plain, simple language to explain results and what the next actions should be, and be supported through the use of trained medical interpreters for patients with limited English proficiency.

Concluded Dr Karliner: “A given health system can take these findings and investigate their own systems to assess whether they might have similar barriers for their patient populations, and then act to address those barriers.”


  1. Patel MI, Lopez AM, Blackstock W, et al. Cancer disparities and health equity: a policy statement from the American Society of Clinical Oncology. J Clin Oncol. Published August 12, 2020. doi:10.1200/JCO.20.00642
  2. Kenny JD, Karliner LS, Kerlikowske K, et al. Organization communications factors and abnormal mammogram follow-up: a qualitative study among ethnically diverse women across three healthcare systems. J Gen Intern Med. Published online June 29, 2020. doi:10.1007/s11606-020-05972-2