SAN ANTONIO – A community breast navigation program in an underserved area of Connecticut successfully improved mammogram screening rates among African American and Latino women, according to a study presented at the 2016 San Antonio Breast Cancer Symposium (SABCS).1
“In the United States in 2013, only 37.1% of uninsured women received mammogram screenings compared to 70.4% of insured women,” said Rasha M. Banks, MPH candidate, The Carole and Ray Neag Comprehensive Cancer Center, UConn Health, Farmington, CT. “To combat barriers to access that cause low rates of mammogram screening, UConn Health, in partnership with Susan G. Komen of Southern New England and Community Health Services, Inc. in Hartford, CT, developed the Community Breast Navigation Program (CBNP).”
Through the CBNP, a community breast navigator was embedded in the adult medicine clinic of Community Health Services for approximately 7 months. The breast navigators primary roles were to provide breast health education, streamline the screening scheduling process, and follow up with patients to reschedule missed appointments.
The navigator also provided solutions to barriers for patients, including supplying a bus pass or gas card; distributing education on breast care and breast cancer; making mammograms and ultrasounds free; providing translation; scheduling appointments; calling to remind patients of appointments; and rescheduling missed or cancelled appointments.
As part of the CNBP, a physician or medical assistant would notify the navigator when a patient had not received a recent mammogram, allowing for navigator to enter the exam room and educate the woman on the importance of maintaining breast health through breast screenings, clinical breast exams, self-breast exams, and early detection. The navigator would then register the patient by calling UConn Health’s patient access department.
After the patient was registered the navigator would call UConn Health’s radiology department with the patient to schedule a breast screening, and would give the patient a contact card, which is a card with the date and time of the appointment, in addition to breast health literature.
One to 3 days prior the appointment, the navigator would call to remind the patient of the appointment, and if the patient failed to attend the appointment, the navigator would contact both the patient and the radiology department to reschedule the screening.
Of the 99 patients referred to receive breast cancer screening, 69.7% were black, 23.2% were Hispanic/Latino, and 6.1% were white. Results showed that 57.6% received the screening. Furthermore, the CNBP improved the rate of uninsured women receiving mammograms to 62.2%, which is 8.1% higher than the rate in Connecticut overall.
The CNBP follow up also appeared to have an impact on patients. Among the 25% who cancelled their first appointment, 17.5% attended the second appointment and 0.7% attended after 2 cancelled appointments.
The researchers indicated the reasons for failed follow-up, which included: out-of-service phone number; failure to answer phone calls or respond to voicemail message; receipt of breast cancer screening elsewhere due to distance of UConn Health; and receipt of breast cancer screening elsewhere due to familiarity with a different imaging center.
Ms Banks explained the influence of the navigator by quoting a participant who said,” I didn’t plan on getting a mammogram but the navigator convinced me to go. And when I needed more images, I didn’t want to go that time either, but she convinced me again.”
Ms Banks also found that the rate of mammogram screening was only 50.7% in black women and 69.6% in Hispanic/Latino women compared with 83.3% in white women, suggesting that additional effort needs to be made to improve screening rates among black and Hispanic women.
1. Banks RM, Stevenson CE. Community breast navigation improves breast cancer screening in Hartford, CT. Poster presented at: 2016 San Antonio Breast Cancer Symposium; December 6-10, 2016; San Antonio, TX.