This document summarizes a study analyzing the impact of the S.A.V.E. Mobile Cancer Screening Program funding diagnostic breast imaging for uninsured women. The study found that funding diagnostic imaging was associated with a significant increase in the percentage of patients completing follow-up imaging, rising from 71% to 84% after the policy change. However, funding did not reduce the time between initial screening and follow-up, which increased slightly. The study concludes that while funding removed financial barriers, other barriers like travel, time, and fear may still prevent some patients from completing follow-up and recommends interventions like flexible appointment times and education.

1. Reducing the Barriers of Out of Pocket Costs of Diagnostic
Breast Imaging for Uninsured Women
Kimberly Le
Dr. Nancy Louis, Preceptor
S.A.V.E. Mobile Cancer Screening Program
NJMS Rutgers - University Hospital
To analyze if the S.A.V.E. Program’s policy
change to begin funding diagnostic breast
imaging:
(1) increases the number of patients who
completed follow-up and
(2) reduces time between screening
and follow-up.
Purpose
Significance
The Screening Access of Value to Essex
Women and Men (S.A.V.E. )Program provides
free cancer screenings for low income and
uninsured residents of Essex County.
About 25% of S.A.V.E. patients who are
screened for breast cancer have unclear or
incomplete results (BI-RADS 0).
BI-RADS 0 indicates that additional imaging
or comparison of prior mammograms is
required for a complete evaluation.
Prior program findings indicate that
approximately 30% of women who need
breast imaging follow-up do not receive it
likely due to out of pocket expenses and/or
difficulty obtaining hospital charity care.
Methodology
 This Rutgers IRB approved Quality
Improvement Assessment Study is a
retrospective review of electronic
medical records in order to identify all S.A.V.E.
patients who required additional
imaging after their initial screening
mammogram.
 After data collection, a proportion of patients
completing follow-up was calculated.
Observed 2 groups for 4 months after Initial
Screening:
I would like to thank my Program Preceptor,
Dr. Nancy Louis,
Research Specialist David Landry,
Program Coordinator, Catherine Marcial,
Outreach Coordinator, Zelia Desouza,
Services Coordinator Evelyn Granger, and
Professor Ann Marie Hill for guiding and
assisting me with this project.
Acknowledgements
Funding diagnostic breast imaging is
associated with a significant increase in the
percentage of patients completing diagnostic
follow up, but it is not associated with any
shortening of the interval between screening
and diagnoses.
The S.A.V.E. Program may have removed the
financial barriers and helped more women
receive diagnostic breast imaging, but other
barriers remain that obstruct patients from
completing follow-up such as travel, time, and
psychological factors.
Further examination of the underlying
factors influencing patient follow-up can be
used to recommend interventions to improve
follow-up such as:
Evaluation
Outcomes
71%
84%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
2014
2015
Percentage of Patients Completing Follow up Breast Imaging
A Higher Proportions of Patient Completing Follow-up
Breast Imaging After Funding Policy Change
1. Normal
mammogram
2. Benign Cyst
(Not Cancer)
3. Breast
Cancer
4. Extremely
Dense Breast
(BI-RADS 0)
Results: From her initial screening mammogram, Photo 4 is found to be an
extremely dense breast image. If the patient didn’t follow-up for a diagnostic
mammogram, she would not have known if there were any harmful lesions
hiding within the dense tissue.
n = 149
n = 150
Permit a Day
for Walk in
Appointments
to Decrease
Missed
Appointments
Employ More
Radiologists to
Make More
Earlier &
Flexible
Appointment
Times
Implement
Electronic
Reminder
System [Email,
Text, Call]
Debunk Fear
of “BI-RADS 0”
through
Education
Breast Imaging Results Comparison:
Is this BI-RADS 0 Benign or Malignant?
Photo Credits: Photo 1 is from National Cancer Institute© Dr. Dwight Kaufman. Photo 2,Background are from © Nevit Dilmen (Wikimedia
Commons). Photo 3,4 is from American College of Radiology [http://www.acr.org/News-Publications/News/News-Articles/2012/ACR-
Bulletin/201210-Shedding-Light-on-Breast-Density]
Clear
Screening
Results
Incomplete
Screening
Results
n = 912
23%
77% Clear
Screening
Results
Incomplete
Screening
Results
n = 948
19%
Percentage of Patients Requiring Breast Imaging Follow-up
20152014
81%
Group 1: 2014
• Patients who were screened
before policy change
• [April–November 2014]
Group 2: 2015
• Patients who were screened
after policy change
• [April–November 2015]
On average, 21% of patients across both periods had
unclear screening results and were recommended for
additional imaging evaluation.
After Funding
Diagnostic Imaging:
• The percentage of
patients who
completed follow-up
increased from 71%
(149 out of 211) to
84% (150 out of 179).
Significantly, 18.7%
more patients
completed follow-up.
Time between
Screening and
Diagnoses:
• The length of time
between screening
results and diagnostic
imaging results did not
shorten as expected.
Instead, the time duration
increased from 58.1 days
to 59.2 days.
Limitation:
• Future research
should examine other
factors that may be
responsible for
increased follow-up
rates (such as patient
demographic
characteristics).