Abstract P3-10-05: Successful implementation of a novel breast cancer navigation program in Nuevo León, México
Authors: Mireles-Aguilar T , Tamez-Salazar JJ , Villarreal-Garza CM , Rodriguez y Silva M , Romero C , Pérez-Reyes P 
Published: March 2017

Abstract
Introduction: Although the overall incidence of breast cancer (BC) is lower in Latin America than in high-income countries, the mortality burden is greater, mainly due to presentation at more advanced stages. Advanced BC presentation has been directly associated to delays by the patient and provider. In Mexico, it has been previously shown that the longest delay occurs within the health system interval, with a median of 5 months. Navigation programs have been proved to be a valuable strategy to assist individuals in overcoming barriers for care across the cancer care continuum. However, its implementation has been limited to date in low-income settings.
Objectives: The aim of this project was to propose a novel BC navigation program to overcome different common barriers for access to accurate diagnosis and early treatment in a limited setting in Nuevo Leon, Mexico. The secondary objectives were to educate and involve medical students by being part of the navigation process and raising women awareness about BC.
Methodology: Through an alliance with the local Ministry of Health, during 18 months, we invited women who had their mammogram done in a referral mammographic center to participate in this Navigation Program. Two weeks after recruitment women were taken by a designated transportation to a specialized BC diagnostic unit, participated in a BC self-awareness educational session (increment in knowledge was measured by pre and post tests), received a clinical breast exam and were provided with their mammography report (interpreted by a breast radiologist). When appropriate, core biopsies were performed and onward referrals to a BC Treatment Center were provided. Along with this process, a Navigator Training Program took place as part of the medical students' 5th year curricula in the ITESM Medical School, within their academic clinical practice (knowledge increment was measured by pre and post tests). This project was supported by Susan G. Komen Foundation.
Results: 1632 low-income uninsured women were navigated and 37 BC were diagnosed. All BC patients started treatment within 3 months from their initial mammogram. 55% were diagnosed at early stages (0-IIA) and 45% at II-B to IV stages (vs. 26% and 74%, respectively, from the overall report from the Ministry of Health in 2014). Patient BC awareness knowledge increased by 22%. 170 students participated in the navigation process, and their knowledge rose by 18% from baseline. The BC Navigation Training Program is now part of the official academic curricula of the ITESM Medical School.
Conclusions: Our Navigation Program was intended to break down medical care barriers to reduce delays and improve quality of care, by guiding Mexican women through the whole continuum of BC diagnosis and early treatment. This successful implementation resulted in shorter health system intervals and BC down staging. Well-designed patient navigation projects should be implemented in low- and middle-income countries to establish their value and feasibility. Due to a lack of educated patient navigators in these regions, health care professionals should be trained to provide navigation guidance through the complex health care systems frequently encountered in underserved settings.
Citation Format: Mireles-Aguilar T, Tamez-Salazar JJ, Villarreal-Garza CM, Rodriguez y Silva M, Romero C, Pérez-Reyes P. Successful implementation of a novel breast cancer navigation program in Nuevo León, México [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-05.