At the CBCC, time to patient follow-up after initial mammographic screening is within the CDC-recommended performance standard of less than 60 days. For a population that historically has low rates of clinical follow-up, we attribute this reduction in delays to breast cancer diagnostic resolution to a culturally sensitive patient navigation program. Additional studies are needed to assess how the existing navigation program can be individualized/tailored to target the remaining 20% of women who did not adhere to the recommended workup.
Data on ethnic variations in breast density are limited and often not inclusive of underrepresented minorities. As breast density is associated with elevated breast cancer risk, investigating racial and ethnic difference may elucidate the observed differences in breast cancer risk among different populations. We reviewed breast density from initial screening of women from the Capital Breast Care Center and Georgetown University Hospital from 2010 to 2014. Patient demographics including race, age at screening, education, menopausal status, and body mass index were abstracted. We recorded the BI-RADS density categories: (1) "fatty," (2) "scattered fibroglandular densities," (3) "heterogeneously dense," and (4) "extremely dense." Multivariable unconditional logistic regression was used to identify predictors of breast density. Density categorization was recorded for 2146 women over the 5-year period, comprising Blacks (n = 940), Hispanics (n = 893), and Whites (n = 314). Analysis of subject characteristics by breast density showed that high category is observed in younger, Hispanic, nulliparous, premenopausal, and nonobese women (t-test or chi-square test, P-values <.0001). Obese women are 70% less likely to have high density. Being Hispanic, premenopausal, and nonobese were predictive of high density on logistic regression. In this analysis of density distribution in a diverse sample, Hispanic women have the highest breast density, followed by Blacks and Whites. Unique in our findings is women who identify as Hispanic have the highest breast density and lower rates of obesity. Further investigation of the impact of obesity on breast density, especially in the understudied Hispanic group is needed.
Washington, DC, has one of the highest incidence and mortality rates for breast cancer in the USA. Patient navigation coupled with informational and community resources are important strategies that assist patients’ access and help them understand the complex world of cancer care. The Georgetown Lombardi Comprehensive Cancer Center’s Capital Breast Care Center (CBCC) is a safety net mammography screening center that utilizes a community-based navigation program. In addition to providing assistance with coordination of clinical services, navigators at CBCC are integral in establishing intra-community partnerships to educate members of the community about breast cancer screening. The aim of this study was to detail die role of patient navigation at the CBCC, with an emphasis on community engagement and community-based partnerships. We describe tire process by which CBCC established partnerships with multiple community organizations between 2004 and 2015 and analyzed data of women screened in relationship to die evolution of the patient navigation services. Application of the CBCC navigation model that integrates individual patient outreach with community engagement has yielded viable and lasting community partnerships that have resulted in an increase in mammography uptake, especially among medically under-served minority women.
Background: Breast cancer screening uptake patterns vary based on race and ethnicity, insurance status, socioeconomic status, and age. Among uninsured and resource-poor populations, community-based safety net clinics have emerged as important providers of these breast cancer screening services. The Capital Breast Care Center (CBCC) was established in 2004 to deliver breast and cervical cancer screening to all women in the District of Columbia (DC) metropolitan region. CBCC serves a large Black and Hispanic population with representation of many diverse ethnic groups within these racial categories. Here, we examine the population of women presenting to CBCC for screening mammograms from 2010 to 2016, evaluating patterns of changes in utilization of the services along sociodemographic and economic lines among the women. Methods: Prospectively collected demographic data were abstracted from the electronic medical records including age, race, menopausal status, insurance status, highest education attainment, and screening outcome. Percentages of women who sought mammography screening were computed for each year by categories of selected characteristics. Time trends in screening were tested with the Cochran-Armitage trend test. Results: From 2010 to 2016, 8448 women were screened at CBCC with 106 diagnoses of breast cancer. African-American and Hispanic women accounted for about 90%. Trends in the racial/ethnic composition of the women screened shifted, with African American women decreasing while the proportion of Latina patients increased (p-value <0.0001). The uninsured population increased covered under the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) as decreases were seen in women with private commercial insurance, Medicaid, and Medicare (p-value <0.0001). The number of DC residents decreased as more patients traveled from Maryland and Virginia (p-value <0.0001). There was no significant trend in proportion of women who had screening and were diagnosed with breast cancer. Conclusion: In this analysis of asymptomatic women presenting for breast cancer screening, over a 7-year period there were significant trends in an increase in Hispanic women, those residing in Virginia, and those screened using the NBCCEDP. These analyses of the population of women selecting CBCC for mammography screening may reflect both local and national demographic shifts. Assessment of patient trends can improve preventative/public health efforts and intervention services offered at community clinics. Citation Format: Bridget A. Oppong, Holly Greenwald, Chiranjeev Dash, Kepher Makambi, Tesha Coleman, Lucile Adams-Campbell. Trends in mammography utilization at a safety net breast cancer screening center [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B22.
Background: The Capital Breast Center (CBCC), in the Washington, DC metro area, is a screening facility established to serve minority and underserved women in an effort to address mammography underutilization. Due to widespread outreach and public service information dissemination, women are having mammograms at increasing rates. Current data from the DC Cancer Consortium show that overall, self-reported rates of cancer screening are higher than those among adults nationwide (86.5% reporting having had a mammogram within the last two years vs. 80% nationally). However, compliance or adherence to follow-up after the initial screening mammogram remains an issue. The Center for Disease Control (CDC) recommends a median of less than 60 days between abnormal mammography results and final diagnosis of breast cancer. We present data on follow-up at CBCC. Methods: All patients screened at CBCC are entered into an electronic medical record (EMR) system starting January 2010. Prospectively collected demographic data was abstracted from the EMR including age, race, insurance status, and the date of the first abnormal screening with the following diagnostic workup. We calculated intervals (in days) between the screening and diagnostic visits. Descriptive statistics and median time to follow-up are reported as the primary outcomes of interest. Differences between Black and Hispanic women on time interval were tested by t-test. Results: From January 2010 to December 2011, 2,430 digital screening mammograms were preformed. Of those who reported race(86%), 46% identified as Black, 37% as Hispanic, and 3% as “Other”. 353 (15%) of the tests yielded an abnormal result. 320 (91%) women returned for the recommended follow-up appointment for diagnostic imaging. The median interval between screening and diagnostic imaging was 40 days (Interquartile range: 28-58 days). Of the 34 women who were recommended to have a core needle biopsy after the diagnostic imaging, 28 (82%) underwent biopsy within a median of 19.00 days (interquartile range: 11-37 days). Overall, there were 5 high risk lesions (atypia) and 19 cancers (1.9 cancers per 1,000) diagnosed in the two year period. There was no statistically significant difference in the interval between screening and diagnostic evaluation or diagnostic mammogram and biopsy between Black and Hispanic women. Conclusion: CBCC, with culturally sensitive patient navigators has managed to get patients to return for follow-up breast care in a timely manner (within the CDC recommended performance standard). For a population that is majority low income Black and Hispanic women with a high risk of noncompliance, we have minimized delays to breast cancer diagnosis by providing navigation services to all patients. Citation Format: Bridget A. Oppong, Chiranjeev Dash, Tesha Coleman, Milajurine T. Lindsay, Shawna Willey, Lucile L. Adams-Campbell. The importance of patient navigation in a high risk screening program: the Capital Breast Care Center experience. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1372. doi:10.1158/1538-7445.AM2013-1372
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