Patient Navigation to reduce breast cancer health disparities among Latinas
Amelie G. Ramirez, Dr.P.H. is director of the Institute for Health Promotion Research (IHPR), part of the School of Medicine. She is an author of an IHPR study that showed Latina women who had abnormal results from a mammogram were more likely to receive follow-up care if they were mentored by a patient navigator.
IHPR researchers worked with partners in the federally funded Redes En Acción: The National Latino Cancer Network to examine the experiences of 425 Latinas in six cities nationwide. Each woman had received an abnormal result in an initial breast cancer screening and was referred for further evaluation.
About half of the women received help from trained patient navigators, who provided culturally sensitive support and help in overcoming barriers related to transportation, child care, insurance coverage, language and more. The rest of the patients did not receive patient navigation.
The study’s patient navigators, all Latinas themselves, were high school graduates between the ages of 25 and 47. They were trained to coordinate care according to the same patient navigation model.
Mentored patients follow up more quickly
For patients who received navigation services, the time between an abnormality being found and eventual diagnosis — whether positive or negative for cancer — was significantly shortened. Those who worked with patient navigators were diagnosed in an average of 32.5 days, compared with 44.6 days for those who did not receive patient navigation.
More specifically, researchers found the greatest benefit for women whose abnormalities were categorized upon discovery as “probably benign” — or BI-RADS-3 on the American College of Radiology’s Breast Imaging-Reporting and Data System. The likelihood of cancer in a woman with a BI-RADS-3 screening result is about 2 to 4 percent.
Health care providers typically instruct these women to return for another screening within six months; however, delays and anxiety occur, appointments are missed and Latinas may skip subsequent screenings altogether, potentially setting the stage for confirmatory diagnoses at more advanced stages of cancer with lower survival probability.
In this study, on average, women with “probably benign” abnormalities received a diagnosis more than 40 days sooner if they worked with a patient navigator.
In women with BI-RADS-4 (“suspicious”) and BI-RADS-5 (“highly suggestive of malignancy”) results, working with a patient navigator made little or no difference in the time from screening to diagnosis - given the greater likelihood for cancer and thus the greater likelihood that women would seek a final diagnosis.
Better outcomes for health
The important conclusion is that this study is a critical first step in identifying specific situations where patient navigation can have the greatest impact on health outcomes.