{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:44:33Z","timestamp":1791816273248,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":41,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","award":["131644\u2010RSGI\u201018\u2010224\u201001\u2010CPHPS"],"award-info":[{"award-number":["131644\u2010RSGI\u201018\u2010224\u201001\u2010CPHPS"]}],"id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Diagnostic follow\u2010up times after abnormal screening mammography vary widely across facilities. However, whether the use of digital breast tomosynthesis (DBT) is associated with follow\u2010up timeliness, independent of facility context factors, remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the extent to which facility mammography volume accounts for the association between facility\u2010level DBT use proportion and recall delay after abnormal screening mammography in Appalachia.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We linked 2016\u20132018 Medicare fee\u2010for\u2010service claims to facility survey data from screening facilities in five Appalachian states (KY, OH, PA, VA, and WV). Recall delay was modeled using linear mixed\u2010effects models with random intercepts for facility and beneficiary. The models adjusted for DBT use proportion, capacity score, age, race, dual Medicare\u2013Medicaid eligibility, deprivation, rurality, and stand\u2010alone status. To assess whether facility mammography volume accounted for the association between DBT use proportion and recall delay, we compared two models fitted to the same analytic sample with the same covariates. The models differed only in whether facility mammography volume was included. We estimated 95% confidence intervals for the difference in the DBT coefficient using 5000 bootstrap resamples. Facility\u2010level models and exploratory mediation analyses were conducted as complementary analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n DBT use proportion was associated with higher facility mammography volume after adjustment for capacity score and facility covariates (\n \u03b2<\/jats:italic>\n \u00a0=\u00a00.614, 95% CI [0.170, 1.058],\n p<\/jats:italic>\n \u00a0=\u00a00.007). After adjustment for capacity score, a 1\u2010SD higher facility mammography volume was associated with shorter recall delay (\n \u03b2<\/jats:italic>\n \u00a0=\u00a0\u22121.103 days, 95% CI [\u22122.074, \u22120.132],\n p<\/jats:italic>\n \u00a0=\u00a00.028). The DBT coefficient changed from \u22120.970 days before adding facility volume to \u22120.402 days after volume adjustment, corresponding to a raw coefficient change of 0.568 days (95% bootstrap CI [0.130, 1.088]). The complementary facility\u2010level model estimated a corresponding raw coefficient change of 0.620 days (95% bootstrap CI [0.149, 1.143]). An exploratory mediation analysis adjusted for capacity score and facility covariates estimated an indirect estimate through facility mammography volume of \u22120.620 days (95% CI [\u22121.111, \u22120.146],\n p<\/jats:italic>\n \u00a0=\u00a00.004). The direct and total estimates were not statistically significant.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Facility\u2010level DBT use proportion was positively associated with facility mammography volume, and higher facility mammography volume was associated with shorter recall delay after adjustment for the capacity score. The association between DBT use proportion and recall delay was not statistically significant either before or after volume adjustment, although the estimated DBT coefficient decreased in magnitude after facility mammography volume was added. These findings suggest that differences in follow\u2010up timeliness may reflect the facility context in which DBT is implemented and support further study of facility\u2010level determinants of diagnostic follow\u2010up.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jrh.70229","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:44:46Z","timestamp":1791812686000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Digital Breast Tomosynthesis Use, Facility Mammography Volume, and Timely Follow\u2010Up After Abnormal Screening Mammograms in Appalachia, United States"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6152-5275","authenticated-orcid":false,"given":"Silas Selorm","family":"Daniels\u2010Donkor","sequence":"first","affiliation":[{"name":"Department of Nursing Research University of Virginia School of Nursing Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4878-0283","authenticated-orcid":false,"given":"Fabian T.","family":"Camacho","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences University of Virginia School of Medicine Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4272-1191","authenticated-orcid":false,"given":"Gloribel","family":"Bonilla","sequence":"additional","affiliation":[{"name":"University of Virginia Comprehensive Cancer Center Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3996-518X","authenticated-orcid":false,"given":"Emma M.","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Nursing Research University of Virginia School of Nursing Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8810-627X","authenticated-orcid":false,"given":"Chris","family":"Louis","sequence":"additional","affiliation":[{"name":"Department of Health Law, Policy, and Management Boston University School of Public Health Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger T.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences University of Virginia School of Medicine Charlottesville Virginia USA"},{"name":"University of Virginia Comprehensive Cancer Center Charlottesville Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"issue":"1","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1186\/s12885-021-08100-3","article-title":"Delayed or Failure to Follow\u2010up Abnormal Breast Cancer Screening Mammograms in Primary Care: A Systematic Review","volume":"21","author":"Reece J. C.","year":"2021","journal-title":"BMC Cancer"},{"issue":"2","key":"e_1_2_11_3_1","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/jrh.12798","article-title":"The Breast\u2010Imaging Operations, Practices and Systems Inventory: A Framework to Examine Mammography Facility Effects on Screening in Rural Communities","volume":"40","author":"Anderson R. T.","year":"2024","journal-title":"The Journal of Rural Health"},{"key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.3389\/fpubh.2014.00087","article-title":"Delay in Breast Cancer: Implications for Stage at Diagnosis and Survival","volume":"2","author":"Caplan L.","year":"2014","journal-title":"Frontiers in Public Health"},{"issue":"7","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1007\/s11606-021-07189-3","article-title":"Delays in Follow\u2010Up Care for Abnormal Mammograms in Mobile Mammography Cersus Fixed\u2010Clinic Patients","volume":"37","author":"Vang S. S.","year":"2022","journal-title":"Journal of General Internal Medicine"},{"key":"e_1_2_11_6_1","volume-title":"JRC Technical Report EUR 28360 EN","author":"Dimitrova N.","year":"2016"},{"issue":"3","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.jacr.2023.09.002","article-title":"Rate and Timeliness of Diagnostic Evaluation and Biopsy After Recall from Screening Mammography in the National Mammography Database","volume":"21","author":"Oluyemi E. T.","year":"2024","journal-title":"Journal of the American College of Radiology"},{"issue":"2","key":"e_1_2_11_8_1","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1148\/radiol.11102472","article-title":"Timeliness of Follow\u2010up after Abnormal Screening Mammogram: Variability of Facilities","volume":"261","author":"Rosenberg R. D.","year":"2011","journal-title":"Radiology"},{"issue":"11","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1038\/bjc.2015.147","article-title":"Effect of Specialized Diagnostic Assessment Units on the Time to Diagnosis in Screen\u2010detected Breast Cancer Patients","volume":"112","author":"Jiang L.","year":"2015","journal-title":"British Journal of Cancer"},{"issue":"16","key":"e_1_2_11_10_1","doi-asserted-by":"crossref","first-page":"2566","DOI":"10.1002\/cncr.28817","article-title":"When Performance Management Works: A Study of the National Breast and Cervical Cancer Early Detection Program","volume":"120","author":"DeGroff A.","year":"2014","journal-title":"Cancer"},{"issue":"16","key":"e_1_2_11_11_1","doi-asserted-by":"crossref","first-page":"2575","DOI":"10.1002\/cncr.28821","article-title":"Using Data to Effectively Manage a National Screening Program","volume":"120","author":"Yancy B.","year":"2014","journal-title":"Cancer"},{"key":"e_1_2_11_12_1","unstructured":"\u201cNational Breast & Cervical Cancer Early Detection Program Program Manual: National Breast & Cervical Cancer Early Detection Program \u201d (2017) https:\/\/dphss.guam.gov\/wp\u2010content\/uploads\/2019\/01\/2017\u2010NBCCEDP\u2010Program\u2010Manual.pdf."},{"issue":"10","key":"e_1_2_11_13_1","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1158\/1055-9965.EPI-12-0535","article-title":"Follow\u2010Up and Timeliness after an Abnormal Cancer Screening Among Underserved, Urban Women in a Patient Navigation Program","volume":"21","author":"Markossian T. W.","year":"2012","journal-title":"Cancer Epidemiology, Biomarkers & Prevention"},{"issue":"11","key":"e_1_2_11_14_1","doi-asserted-by":"crossref","first-page":"2811","DOI":"10.1007\/s11606-022-07641-y","article-title":"Impact of Patient Navigation on Population\u2010Based Breast Screening: A Systematic Review and Meta\u2010Analysis of Randomized Clinical Trials","volume":"37","author":"Tian L.","year":"2022","journal-title":"Journal of General Internal Medicine"},{"issue":"9","key":"e_1_2_11_15_1","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1093\/jnci\/djy121","article-title":"Breast Cancer Screening Using Tomosynthesis or Mammography: A Meta\u2010Analysis of Cancer Detection and Recall","volume":"110","author":"Marinovich M. L.","year":"2018","journal-title":"JNCI: Journal of the National Cancer Institute"},{"issue":"8","key":"e_1_2_11_16_1","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/j.jacr.2025.04.008","article-title":"Diagnostic Management Pathways for Workup of Abnormal Screening with Digital Mammography Versus Digital Breast Tomosynthesis","volume":"22","author":"Henderson L. 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E.","year":"2013","journal-title":"Medical Care"},{"issue":"11","key":"e_1_2_11_25_1","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.3390\/ijerph13111156","article-title":"The Impact of Rurality and Disadvantage on the Diagnostic Interval for Breast Cancer in a Large Population\u2010Based Study of 3202 Women in Queensland","volume":"13","author":"Youl P. H.","year":"2016","journal-title":"Australia International Journal of Environmental Research and Public Health"},{"key":"e_1_2_11_26_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.ypmed.2021.106741","article-title":"Identifying Key Barriers to Effective Breast Cancer Control in Rural Settings","volume":"152","author":"Sprague B. L.","year":"2021","journal-title":"Preventive Medicine"},{"issue":"10","key":"e_1_2_11_27_1","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1038\/bjc.2017.87","article-title":"Evaluating Wait Times From Screening to Breast Cancer Diagnosis Among Women Undergoing Organised Assessment vs Usual Care","volume":"116","author":"Chiarelli A. M.","year":"2017","journal-title":"British Journal of Cancer"}],"container-title":["The Journal of Rural Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70229","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jrh.70229","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.70229","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:44:51Z","timestamp":1791812691000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jrh.70229"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/jrh.70229"],"URL":"https:\/\/doi.org\/10.1111\/jrh.70229","archive":["Portico"],"relation":{},"ISSN":["0890-765X","1748-0361"],"issn-type":[{"value":"0890-765X","type":"print"},{"value":"1748-0361","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"assertion":[{"value":"2026-02-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70229"}}