Abstract P3-10-13: Community breast navigation improves breast cancer screening in Hartford, CT
Authors: RM Banks, CE Stevenson
Journal: Cancer Research (2017)

Abstract Purpose The Community Breast Navigation Program (CBNP) through UConn Health (UCH), in partnership with Susan G. Komen of CT and Community Health Services, Inc. (CHS) in Hartford, CT attempted to address disparities in breast cancer screenings by embedding a Community Breast Navigator (CBN) in the adult medicine clinic of CHS from September 23, 2015 until April 25, 2016. The CBN's principle roles are to provide breast health education, streamline screening scheduling, and follow-up to reschedule missed appointments. The program was implemented to combat barriers to access which cause low rates of mammogram screening. In the United States in 2013, only 37.1% of uninsured women received mammogram screenings compared to 70.4% of insured women. The community breast navigator aims to capture uninsured and underinsured women in an underserved community to improve mammography screenings and early detection of breast cancer. Scope The objective of the CBNP is to service uninsured and underinsured African-American and Latino women age 40 and over. The mammograms and ultrasounds are offered free of charge to the patient. The costs of the screenings are paid by private donations to UCH. The patient is also offered a gas card or one-day bus pass to provide transportation assistance. Methods The CBN educates women on the importance of maintaining breast health through breast screenings, clinical breast exams, and self-breast exams and contacts patient access and radiology departments at UCH to schedule screenings. The patient is reminded of the mammogram screening 1-3 days before the appointment. If the patient fails to attend the appointment the CBN contacts the patient and UCH to reschedule the screening. Results Within 7 months at CHS, 57 (57.6%) of the 99 women referred in the study period received recommended breast screenings. 75.4% of women attended the breast screening with no cancelled appointments, 17.5% of women attended after one cancelled appointment, and 0.7% attended after two cancelled appointments. In CT in 2014, 54.1% of uninsured women received mammogram screenings; through the CBNP 62.2% of uninsured women received mammogram screenings, an improvement of 8.1% in our population. Also, transportation assistance was provided to 32% of patients. Conclusion To decrease barriers and increase access the CBN scheduled and rescheduled breast screenings. Mammograms costing $478 for 2D and $518 for 3D imaging were offered at no cost and gas and bus vouchers were provided to patients. The CBNP addressed common barriers which are cost, transportation, and scheduling to improve mammography screenings and early detection of cancer. Not receiving breast screening was attributed to out-of-service phone numbers, unanswered phone calls and decisions to receive breast screening elsewhere due to the proximity or familiarity with another imaging center. This program should be modeled in health centers and underserved communities to improve mammography screening and close the gap between insured and un/under-insured patients. The most important concepts for the CBNP are to alleviate the patient's barriers and provide a seamless process to receive breast screening.Purpose The Community Breast Navigation Program (CBNP) through UConn Health (UCH), in partnership with Susan G. Komen of CT and Community Health Services, Inc. (CHS) in Hartford, CT attempted to address disparities in breast cancer screenings by embedding a Community Breast Navigator (CBN) in the adult medicine clinic of CHS from September 23, 2015 until April 25, 2016. The CBN's principle roles are to provide breast health education, streamline screening scheduling, and follow-up to reschedule missed appointments. The program was implemented to combat barriers to access which cause low rates of mammogram screening. In the United States in 2013, only 37.1% of uninsured women received mammogram screenings compared to 70.4% of insured women. The community breast navigator aims to capture uninsured and underinsured women in an underserved community to improve mammography screenings and early detection of breast cancer. Scope The objective of the CBNP is to service uninsured and underinsured African-American and Latino women age 40 and over. The mammograms and ultrasounds are offered free of charge to the patient. The costs of the screenings are paid by private donations to UCH. The patient is also offered a gas card or one-day bus pass to provide transportation assistance. Methods The CBN educates women on the importance of maintaining breast health through breast screenings, clinical breast exams, and self-breast exams and contacts patient access and radiology departments at UCH to schedule screenings. The patient is reminded of the mammogram screening 1-3 days before the appointment. If the patient fails to attend the appointment the CBN contacts the patient and UCH to reschedule the screening. Results Within 7 months at CHS, 57 (57.6%) of the 99 women referred in the study period received recommended breast screenings. 75.4% of women attended the breast screening with no cancelled appointments, 17.5% of women attended after one cancelled appointment, and 0.7% attended after two cancelled appointments. In CT in 2014, 54.1% of uninsured women received mammogram screenings; through the CBNP 62.2% of uninsured women received mammogram screenings, an improvement of 8.1% in our population. Also, transportation assistance was provided to 32% of patients. Conclusion To decrease barriers and increase access the CBN scheduled and rescheduled breast screenings. Mammograms costing $478 for 2D and $518 for 3D imaging were offered at no cost and gas and bus vouchers were provided to patients. The CBNP addressed common barriers which are cost, transportation, and scheduling to improve mammography screenings and early detection of cancer. Not receiving breast screening was attributed to out-of-service phone numbers, unanswered phone calls and decisions to receive breast screening elsewhere due to the proximity or familiarity with another imaging center. This program should be modeled in health centers and underserved communities to improve mammography screening and close the gap between insured and un/under-insured patients. The most important concepts for the CBNP are to alleviate the patient's barriers and provide a seamless process to receive breast screening. Citation Format: Banks RM, Stevenson CE. Community breast navigation improves breast cancer screening in Hartford, CT [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 P3-10-13.