Abstract A100: Timely follow-up after an abnormal breast and cervical cancer screening among underserved, urban women in a patient navigation program
Authors: Markossian Talar , Calhoun Elizabeth , Darnell Julie 
Published: June 2012

Introduction: Uninsured, low-income, and racial/ethnic minority patients are less likely to receive recommended cancer care when compared to insured, high-income whites because these patients experience significant barriers in obtaining health care. Cancer patient navigation, introduced two decades ago, has been advocated as a possible approach to address barriers to obtaining cancer care in underserved populations. The objective of this study is to evaluate the efficacy of a patient navigator intervention in reducing time from breast and cervical cancer screening abnormality to a definitive diagnosis of cancer or resolution of abnormality (for those who do not have cancer) among underserved women living in an urban setting. This study also aims to identify characteristics of patients that are associated with time to diagnostic resolution.

Methods: A total of 5 community health centers and one major safety net hospital in the region participated in recruiting patients for breast and cervical cancer navigation. Concurrent controls were sampled from 20 sites. Matching was conducted by site; sites were matched if they served patients with similar demographics. Data were collected via patient interviews and medical chart reviews. Women were eligible if they had abnormal breast and/or cervical cancer screening. Predictor variables are race/ethnicity, age, primary language, primary care status, and primary and secondary insurance. In women who received navigation, we compare the median number of days to diagnostic resolution by the intensity level of navigation. We use Cox proportional hazard regression models to examine the effects of patient navigation and participants’ characteristics on time from abnormal screening to final diagnostic resolution (the date at which the diagnostic test that resulted in definitive diagnosis was performed). All analyses are stratified by abnormal breast and cervical eligibility event results. Strata for breast include BIRADS 0, 3, 4/5 or eligible due to abnormal clinical breast exam, and strata for cervical include low grade and high grade. Larger hazard ratios are better in this study and are associated with shorter time to diagnostic resolution.

Results: Of the 1,106 women who were eligible to participate for breast and cervical intervention; 1,054 (95.3%) were enrolled and 52 (4.7%) refused to participate. Our data suggest that patient navigation improves time to diagnostic resolution for abnormal breast (HR, 1.53; 95%CI, 1.19–1.97) and cervical (HR, 1.74; 95%CI, 1.41–2.14) screening among low-income racial/ethnic minority urban women. Navigation intensity is not associated with time to diagnostic resolution for abnormal breast and cervical screening controlling for all predictors. Significant predictors of time to diagnostic resolution include: (1) Hispanic ethnicity; Hispanic women complete diagnostic test that result in definitive diagnosis for abnormal breast (HR, 1.66; 95%CI, 1.22–2.26) and cervical (HR, 1.58; 95%CI, 1.21–2.06) cancer screening in shorter time when compared to Black women. (2) Age; women younger than 40 complete diagnostic test for abnormal breast (HR, 1.90; 95%CI, 1.37–2.63) screening in shorter time when compared to women between ages 41 and 50. This is not the case for abnormal cervical screening. (3) Insurance status; in urban safety net system, uninsured women who participate in the Illinois Breast and Cervical Cancer Program (IBCCP) complete diagnostic test for abnormal cervical screening in shorter time when compared to women who have public or some form of private health insurance.

Conclusions: Results from this study will provide information for building evidence for the efficacy of patient navigation intervention in reducing cancer health disparities.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A100.