Abstract 4450: Navigating Latinas with breast screen abnormalities to diagnosis: The Six Cities Study
Authors: Ramirez Amelie G. , Perez-Stable Eliseo , Talavera Gregory A. , Penedo Frank J. , Carillo J. Emilio , Fernandez Maria E. , Holden Alan E C , Miguel Sandra L. San , Munoz Edgar , Gallion Kipling J. 
Published: August 2012

Abstract
BACKGROUND: We sought to compare time from initial abnormal breast screen to definitive diagnosis between navigated and non-navigated patients in racially/ethnically diverse Latina women in six U.S. cities. METHODS: Eligible Latinas had an abnormality of BIRADS 3, 4, or 5 detected on a mammogram, clinical breast exam, magnetic resonance imaging, or ultrasound between July 2008 and December 2010 in six U.S. cities (San Antonio, Miami, Houston, San Diego, New York, and San Francisco). Data were pooled for this analysis. Navigated patients received assistance by locally trained navigators using a patient-centered model suggested by Harold Freeman and endorsed by the Institute of Medicine. Non-navigated patient data was obtained via retrospective medical chart review. We used Log-Rank Chi-squared tests to evaluate bivariate associations with dependent variables and Kaplan-Meier and Cox Proportional Hazards analyses to compare time-to-diagnosis and timely diagnosis estimates between Navigated and Control group Latinas. RESULTS: Among 480 women with initial BIRADS 3, 4, or 5 results, follow-up data was available for 425 (88.5%). Radiologic classification of initial abnormality (BIRADS), rather than any other sociodemographic or clinical characteristic was the only significant predictor of overall and timely diagnosis. Data for women with an initial BIRADS 3 result were adjusted to control clinician-imposed diagnostic delays. Of all women, &gt; 95% achieved definitive diagnosis within 180 days. Median time to definitive diagnosis was significantly reduced among navigated compared to non-navigated Latinas (20 days versus 27 days, hazard ratio [HR] 1.32, p = .007). This translates to a 132% increase in rates of diagnosis among navigated women. This effect was primarily observed in women with an initial BIRADS 3 result, especially when adjusted for clinically directed waiting periods between initial and follow-up screening examinations. Among navigated patients, only between-BIRADS variation rather than sociodemographic characteristics, number of barriers to care, insurance status or type or site-specific variables were associated with timely or time-to-diagnosis. CONCLUSIONS: Patient-centered navigation to assist Latina women with breast screening abnormalities reduces median time-to-diagnosis by approximately 25% when types of screening abnormality and barriers to care are addressed at patient level. Community-based interventions may be the most effective means to reduce cancer health disparities when addressing the needs of underserved populations.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4450. doi:1538-7445.AM2012-4450