Abstract 4450: Navigating Latinas with breast screen abnormalities to diagnosis: The Six Cities Study

Abstract

BACKGROUND: We sought to compare time from initial abnormal breast screen to definitive diagnosis between navigated and non-navigated patients in racially/ethnically diverse Latina women in six U.S. cities. METHODS: Eligible Latinas had an abnormality of BIRADS 3, 4, or 5 detected on a mammogram, clinical breast exam, magnetic resonance imaging, or ultrasound between July 2008 and December 2010 in six U.S. cities (San Antonio, Miami, Houston, San Diego, New York, and San Francisco). Data were pooled for this analysis. Navigated patients received assistance by locally trained navigators using a patient-centered model suggested by Harold Freeman and endorsed by the Institute of Medicine. Non-navigated patient data was obtained via retrospective medical chart review. We used Log-Rank Chi-squared tests to evaluate bivariate associations with dependent variables and Kaplan-Meier and Cox Proportional Hazards analyses to compare time-to-diagnosis and timely diagnosis estimates between Navigated and Control group Latinas. RESULTS: Among 480 women with initial BIRADS 3, 4, or 5 results, follow-up data was available for 425 (88.5%). Radiologic classification of initial abnormality (BIRADS), rather than any other sociodemographic or clinical characteristic was the only significant predictor of overall and timely diagnosis. Data for women with an initial BIRADS 3 result were adjusted to control clinician-imposed diagnostic delays. Of all women, > 95% achieved definitive diagnosis within 180 days. Median time to definitive diagnosis was significantly reduced among navigated compared to non-navigated Latinas (20 days versus 27 days, hazard ratio [HR] 1.32, p = .007). This translates to a 132% increase in rates of diagnosis among navigated women. This effect was primarily observed in women with an initial BIRADS 3 result, especially when adjusted for clinically directed waiting periods between initial and follow-up screening examinations. Among navigated patients, only between-BIRADS variation rather than sociodemographic characteristics, number of barriers to care, insurance status or type or site-specific variables were associated with timely or time-to-diagnosis. CONCLUSIONS: Patient-centered navigation to assist Latina women with breast screening abnormalities reduces median time-to-diagnosis by approximately 25% when types of screening abnormality and barriers to care are addressed at patient level. Community-based interventions may be the most effective means to reduce cancer health disparities when addressing the needs of underserved populations. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4450. doi:1538-7445.AM2012-4450

The Yo me cuido® Program: Addressing Breast Cancer Screening and Prevention Among Hispanic Women

“…A host of programs have been designed and implemented to address breast cancer prevention and early detection, as well as healthy lifestyles, among Hispanic women [18,[28][29][30][31][32][33][34]. These programs have utilized evidence-based health education and community outreach methods (e.g., client reminders, media campaign, multilingual education materials, individualized education, and access issues [costs and availability]) to increase participation, enhance knowledge of cancer, and increase screening behaviors [19].…”

“…Many community-based programs and research efforts have set forth basic tenets for working with Hispanic communities, namely recognizing the impacts of cultural characteristics such as respeto (respecting of cultural norms, roles, expectations, and community), personalismo (establishing personal relationships where individuals feel that one cares about them as a human being and their specific problems and needs), confianza (creating an environment of trust where individuals feel that they can count on one not to take advantage of them, and that one has their best interest at heart-an open book), simpatía (feeling liked, admired, and understood, and that one is genuinely concerned for them), and familia (working with Hispanic communities should generally be understood as a family and community experience, and where collaborative partnerships with community-based organizations serving these communities is paramount) [28,[37][38][39]. Although these tenets are discussed in similar programs they are not highlighted as a foundation for working with Hispanic populations [18,[29][30][31][32][33][34]. YMC is a program molded into one that is personal, intimate, interpersonal, culturally-based, and designed to make the participants feel special and valued, like part of an extended family.…”

Using Patient Navigation to Solve Latino Cancer Health Disparities

“…Latinos have higher rates of liver, cervical, and other cancers, have lower cancer screening rates, and are diagnosed at more advanced, less treatable cancer stages than non-Latinos.Patient navigation is an emerging way to tackle these grave disparities.In fact, bilingual, bicultural patient navigation can effectively guide Latino cancer patients and survivors through the complex care system, increasing timely diagnosis and treatment [1][2][3]. Now researchers are taking navigation to innovative new levels, beyond just helping patients.…”

“…Our subsequent clinical trials hypothesized, and went on to prove, that patient navigation by a bilingual, bicultural patient navigator can reduce Latinas' times to diagnosis and treatment and significantly increase the proportion of Latinas initiating treatment. Navigation indeed is likely to have saved the lives of many Latinas in these studies [1][2][3]. Those studies opened new doors.…”

“…In fact, bilingual, bicultural patient navigation can effectively guide Latino cancer patients and survivors through the complex care system, increasing timely diagnosis and treatment [1][2][3]. Now researchers are taking navigation to innovative new levels, beyond just helping patients.…”