Abstract B108: Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago
Authors: Henderson Vida , Watson Karriem , Tossas-Milligan Kathy , Martinez Erica , Rodriguez Mariela , Williams Barbara , Torres Paola , Aponte-Soto Lisa , Winn Robert 
Published: August 2020

Background: Under-resourced women are subject to many factors that increase their risk of morbidity and mortality from breast cancer, such as being uninsured or underinsured and not having a medical home or primary care provider. They may also lack additional resources to access care such as transportation. Due to variance in mammography recommendations among health organizations, lack of knowledge or confusion about when to receive screening also poses a challenge to both women and providers.

Objective: A partnership between University of Illinois (UI) Cancer Center, UI Hospital & Health System, and Chicago Department of Public Health was developed to initiate an implementation science program that aims to mitigate these barriers by providing free breast cancer screening services and patient navigation to under-resourced women at our Mile Square Federally Qualified Health Centers (FQHCs). The program also aims to increase community partnerships to extend community outreach and identify factors that facilitate or challenge women's access to breast care services.

Methods: Breast health screening and navigation services are offered at 5 Mile Square FQHC clinics and through “mammography party” events with community partners. Navigators facilitate women's care through screening and any follow-up services, link patients to additional resources, and provide breast health education. Data obtained through electronic medical records and direct correspondence with women and providers are managed securely in REDCap and analyzed with SPSS software. A program evaluation will be implemented in September 2018. Program activities are ongoing.

Results: Four hundred ten women completed a screening mammogram from August 1, 2017 to June 30, 2018. Ninety-seven percent of women were racial minorities, most of whom were Latina (60.2%), African American (31.5%) and uninsured (67.8%). Among this cohort of women, the recall rate (24.6%) and cancer detection rate (17 per 1000) exceeded Breast Cancer Surveillance Consortium 2013 recall and cancer detection rate benchmarks (11.5% and 4.8 per 1000, respectively). Ages of women diagnosed (n=7) ranged from 40 to 68 years. The majority of diagnosed women were uninsured (n=6), 4 of whom were not eligible for health insurance.

Conclusion: Patient navigation has proven to be effective in increasing breast cancer screening rates, access to care and resources, and disseminating breast health education; however, systematic barriers to care still persist. Although the Affordable Care Act has been instrumental in increasing the number of insured Americans, health care costs still pose a significant challenge for those who are underinsured or not eligible to be insured. Additionally, our data imply that some recommended guidelines for mammography may not address the screening needs for women who are at higher risk for breast cancer, and more personalized screening based on a woman's individual risk factors may be instrumental in ameliorating breast cancer disparities.

Citation Format: Vida Henderson, Karriem Watson, Kathy Tossas-Milligan, Erica Martinez, Mariela Rodriguez, Barbara Williams, Paola Torres, Lisa Aponte-Soto, Robert Winn. Using patient navigation to inform determinants of breast cancer disparities among under-resourced women in Chicago [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B108.