Adding a patient navigation component to a population-based information technology (IT) system significantly improved screening rates for breast cancer, cervical cancer, and colorectal cancer in patients at high risk for nonadherence with testing, a study published in JAMA Internal Medicine has shown.1

Because patient navigation aimed at increasing cancer screening rates in low-income and racial/ethnic minority populations typically focuses on navigating for single cancers in community health center settings, researchers at Massachusetts General Hospital in Boston and the Chelsea HealthCare Center in Chelsea, MA, sought to evaluate patient navigation for breast, cervical, and colorectal cancer screening using a population-based IT system within a primary care network.

For the study, investigators enrolled 1612 patients from 18 practices in an academic primary care network who were overdue for cancer screening and were managed using a population-based IT system. All patients were deemed to be at high risk for nonadherence after completing screening based on an algorithm that included factors like language spoken, number of overdue tests, and no-show visit history.

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Patients were randomly assigned 1:1 to patient navigation, which involved navigators using the IT system to track patients, contact them, and provide intense outreach to help them complete cancer screening, or usual care.

Results showed that the average proportion of patients who were up to date with screening among all overdue screening examinations was higher in the navigation group compared with the usual care group for all cancers combined (10.2% vs 6.8%; 95% CI, 1.5-5.2; P < .001), and for breast (14.7% vs 11.0%; 95% CI, 0.2-7.3; P = .04), cervical (11.1% vs 5.7%; 95% CI, 0.8-5.2; P = .002), and colon (7.6% vs 4.6%; 95% CI, 0.8-5.2; P = .01) cancer.

Researchers also found that the proportion of overdue patients who completed any cancer screening during follow-up was higher in the navigation (25.5% vs 17.0%; 95% CI, 4.7-12.7; P < .001).

The study further demonstrated that more patients in the navigation group completed screening for breast (23.4% vs 16.6%; 95% CI, 1.8-12.0; P = .009), cervical (14.4% vs 8.6%; 95% CI, 1.6-10.5; P = .007), and colorectal (13.7% vs 7.0%; 95% CI, 3.2-10.4; P < .001) cancer.

“Integrating patient navigation into population health management activities for low-income and racial/ethnic minority patients might improve equity of cancer care,” the authors concluded.


1. Percac-Lima S, Ashburner JM, Zai AH, Chang Y, Oo SA, Guimaraes E, et al. Patient navigation for comprehensive cancer screening in high-risk patients using a population-based health information technology system [published online ahead of print June 6, 2016]. JAMA Intern Med. doi: 10.1001/jamainternmed.2016.0841.