Navigating Latinas with breast screen abnormalities to diagnosis: The Six Cities Study

Amelie G Ramirez, Eliseo J. Pérez-Stable, Frank J. Penedo, Gregory A. Talavera, J. Emilio Carrillo, Maria E. Fernandez, Alan E C Holden, Edgar Munoz, Sandra San Miguel, Kip Gallion

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BACKGROUND. Breast cancer is the leading cause of cancer-related deaths in Latinas, chiefly because of later diagnosis. The time from screening to diagnosis is critical to optimizing cancer care, yet the efficacy of navigation in reducing it is insufficiently documented. Here, the authors evaluate a culturally sensitive patient navigation program to reduce the time to diagnosis and increase the proportions of women diagnosed within 30 days and 60 days. METHODS. The authors analyzed 425 Latinas who had Breast Imaging Reporting and Data System (BI-RADS) radiologic abnormalities categorized as BI-RADS-3, BI-RADS-4, or BI-RADS-5 from July 2008 to January 2011. There were 217 women in the navigated group and 208 women in the control group. Women were navigated by locally trained navigators or were not navigated (data for this group were abstracted from charts). The Kaplan-Meier method, Cox proportional hazards regression, and logistic regression were used to determine differences between groups. RESULTS. The time to diagnosis was shorter in the navigated group (mean, 32.5 days vs 44.6 days in the control group; hazard ratio, 1.32; P =.007). Stratified analysis revealed that navigation significantly shortened the time to diagnosis among women who had BI-RADS-3 radiologic abnormalities (mean, 21.3 days vs 63.0 days; hazard ratio, 2.42; P <.001) but not among those who had BI-RADS-4 or BI-RADS-5 radiologic abnormalities (mean, 37.6 days vs 36.9 days; hazard ratio, 0.98; P =.989). Timely diagnosis occurred more frequently among navigated Latinas (within 30 days: 67.3% vs 57.7%; P =.045; within 60 days: 86.2% vs 78.4%; P =.023). This was driven by the BI-RADS-3 strata (within 30 days: 83.6% vs 50%; P <.001; within 60 days: 94.5% vs 67.2%; P <.001). A lack of missed appointments was associated with timely diagnosis. CONCLUSIONS. Patient-centered navigation to assist Latina women with abnormal screening mammograms appeared to reduced the time to diagnosis and increase rates of timely diagnosis overall. However, in stratified analyses, only navigated Latinas with an initial BI-RADS-3 screen benefited, probably because of a reduction in missed diagnostic appointments. Cancer 2013. © 2012 American Cancer Society. Patient-centered navigation to assist Latina women with abnormal screening mammograms appears to reduce the time to diagnosis and increase rates of timely diagnosis overall. However, results from stratified analysis indicate that only navigated Latinas with an initial Breast Imaging Reporting and Data System (BI-RADS) screening result of BI-RADS-3 are diagnosed more quickly and more often within 30 or 60 days of mammogram abnormality detection.

Original languageEnglish (US)
Pages (from-to)1298-1305
Number of pages8
JournalCancer
Volume119
Issue number7
DOIs
StatePublished - Apr 1 2013

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Hispanic Americans
Information Systems
Breast
Patient Navigation
Appointments and Schedules
Neoplasms
Control Groups
Delayed Diagnosis
Logistic Models
Breast Neoplasms

Keywords

  • BI-RADS
  • breast cancer
  • Breast Imaging Reporting and Data System
  • health disparities
  • Latinas
  • patient navigation

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Ramirez, A. G., Pérez-Stable, E. J., Penedo, F. J., Talavera, G. A., Carrillo, J. E., Fernandez, M. E., ... Gallion, K. (2013). Navigating Latinas with breast screen abnormalities to diagnosis: The Six Cities Study. Cancer, 119(7), 1298-1305. https://doi.org/10.1002/cncr.27912

Navigating Latinas with breast screen abnormalities to diagnosis : The Six Cities Study. / Ramirez, Amelie G; Pérez-Stable, Eliseo J.; Penedo, Frank J.; Talavera, Gregory A.; Carrillo, J. Emilio; Fernandez, Maria E.; Holden, Alan E C; Munoz, Edgar; San Miguel, Sandra; Gallion, Kip.

In: Cancer, Vol. 119, No. 7, 01.04.2013, p. 1298-1305.

Research output: Contribution to journalArticle

Ramirez, AG, Pérez-Stable, EJ, Penedo, FJ, Talavera, GA, Carrillo, JE, Fernandez, ME, Holden, AEC, Munoz, E, San Miguel, S & Gallion, K 2013, 'Navigating Latinas with breast screen abnormalities to diagnosis: The Six Cities Study', Cancer, vol. 119, no. 7, pp. 1298-1305. https://doi.org/10.1002/cncr.27912
Ramirez AG, Pérez-Stable EJ, Penedo FJ, Talavera GA, Carrillo JE, Fernandez ME et al. Navigating Latinas with breast screen abnormalities to diagnosis: The Six Cities Study. Cancer. 2013 Apr 1;119(7):1298-1305. https://doi.org/10.1002/cncr.27912
Ramirez, Amelie G ; Pérez-Stable, Eliseo J. ; Penedo, Frank J. ; Talavera, Gregory A. ; Carrillo, J. Emilio ; Fernandez, Maria E. ; Holden, Alan E C ; Munoz, Edgar ; San Miguel, Sandra ; Gallion, Kip. / Navigating Latinas with breast screen abnormalities to diagnosis : The Six Cities Study. In: Cancer. 2013 ; Vol. 119, No. 7. pp. 1298-1305.
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abstract = "BACKGROUND. Breast cancer is the leading cause of cancer-related deaths in Latinas, chiefly because of later diagnosis. The time from screening to diagnosis is critical to optimizing cancer care, yet the efficacy of navigation in reducing it is insufficiently documented. Here, the authors evaluate a culturally sensitive patient navigation program to reduce the time to diagnosis and increase the proportions of women diagnosed within 30 days and 60 days. METHODS. The authors analyzed 425 Latinas who had Breast Imaging Reporting and Data System (BI-RADS) radiologic abnormalities categorized as BI-RADS-3, BI-RADS-4, or BI-RADS-5 from July 2008 to January 2011. There were 217 women in the navigated group and 208 women in the control group. Women were navigated by locally trained navigators or were not navigated (data for this group were abstracted from charts). The Kaplan-Meier method, Cox proportional hazards regression, and logistic regression were used to determine differences between groups. RESULTS. The time to diagnosis was shorter in the navigated group (mean, 32.5 days vs 44.6 days in the control group; hazard ratio, 1.32; P =.007). Stratified analysis revealed that navigation significantly shortened the time to diagnosis among women who had BI-RADS-3 radiologic abnormalities (mean, 21.3 days vs 63.0 days; hazard ratio, 2.42; P <.001) but not among those who had BI-RADS-4 or BI-RADS-5 radiologic abnormalities (mean, 37.6 days vs 36.9 days; hazard ratio, 0.98; P =.989). Timely diagnosis occurred more frequently among navigated Latinas (within 30 days: 67.3{\%} vs 57.7{\%}; P =.045; within 60 days: 86.2{\%} vs 78.4{\%}; P =.023). This was driven by the BI-RADS-3 strata (within 30 days: 83.6{\%} vs 50{\%}; P <.001; within 60 days: 94.5{\%} vs 67.2{\%}; P <.001). A lack of missed appointments was associated with timely diagnosis. CONCLUSIONS. Patient-centered navigation to assist Latina women with abnormal screening mammograms appeared to reduced the time to diagnosis and increase rates of timely diagnosis overall. However, in stratified analyses, only navigated Latinas with an initial BI-RADS-3 screen benefited, probably because of a reduction in missed diagnostic appointments. Cancer 2013. {\circledC} 2012 American Cancer Society. Patient-centered navigation to assist Latina women with abnormal screening mammograms appears to reduce the time to diagnosis and increase rates of timely diagnosis overall. However, results from stratified analysis indicate that only navigated Latinas with an initial Breast Imaging Reporting and Data System (BI-RADS) screening result of BI-RADS-3 are diagnosed more quickly and more often within 30 or 60 days of mammogram abnormality detection.",
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author = "Ramirez, {Amelie G} and P{\'e}rez-Stable, {Eliseo J.} and Penedo, {Frank J.} and Talavera, {Gregory A.} and Carrillo, {J. Emilio} and Fernandez, {Maria E.} and Holden, {Alan E C} and Edgar Munoz and {San Miguel}, Sandra and Kip Gallion",
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TY - JOUR

T1 - Navigating Latinas with breast screen abnormalities to diagnosis

T2 - The Six Cities Study

AU - Ramirez, Amelie G

AU - Pérez-Stable, Eliseo J.

AU - Penedo, Frank J.

AU - Talavera, Gregory A.

AU - Carrillo, J. Emilio

AU - Fernandez, Maria E.

AU - Holden, Alan E C

AU - Munoz, Edgar

AU - San Miguel, Sandra

AU - Gallion, Kip

PY - 2013/4/1

Y1 - 2013/4/1

N2 - BACKGROUND. Breast cancer is the leading cause of cancer-related deaths in Latinas, chiefly because of later diagnosis. The time from screening to diagnosis is critical to optimizing cancer care, yet the efficacy of navigation in reducing it is insufficiently documented. Here, the authors evaluate a culturally sensitive patient navigation program to reduce the time to diagnosis and increase the proportions of women diagnosed within 30 days and 60 days. METHODS. The authors analyzed 425 Latinas who had Breast Imaging Reporting and Data System (BI-RADS) radiologic abnormalities categorized as BI-RADS-3, BI-RADS-4, or BI-RADS-5 from July 2008 to January 2011. There were 217 women in the navigated group and 208 women in the control group. Women were navigated by locally trained navigators or were not navigated (data for this group were abstracted from charts). The Kaplan-Meier method, Cox proportional hazards regression, and logistic regression were used to determine differences between groups. RESULTS. The time to diagnosis was shorter in the navigated group (mean, 32.5 days vs 44.6 days in the control group; hazard ratio, 1.32; P =.007). Stratified analysis revealed that navigation significantly shortened the time to diagnosis among women who had BI-RADS-3 radiologic abnormalities (mean, 21.3 days vs 63.0 days; hazard ratio, 2.42; P <.001) but not among those who had BI-RADS-4 or BI-RADS-5 radiologic abnormalities (mean, 37.6 days vs 36.9 days; hazard ratio, 0.98; P =.989). Timely diagnosis occurred more frequently among navigated Latinas (within 30 days: 67.3% vs 57.7%; P =.045; within 60 days: 86.2% vs 78.4%; P =.023). This was driven by the BI-RADS-3 strata (within 30 days: 83.6% vs 50%; P <.001; within 60 days: 94.5% vs 67.2%; P <.001). A lack of missed appointments was associated with timely diagnosis. CONCLUSIONS. Patient-centered navigation to assist Latina women with abnormal screening mammograms appeared to reduced the time to diagnosis and increase rates of timely diagnosis overall. However, in stratified analyses, only navigated Latinas with an initial BI-RADS-3 screen benefited, probably because of a reduction in missed diagnostic appointments. Cancer 2013. © 2012 American Cancer Society. Patient-centered navigation to assist Latina women with abnormal screening mammograms appears to reduce the time to diagnosis and increase rates of timely diagnosis overall. However, results from stratified analysis indicate that only navigated Latinas with an initial Breast Imaging Reporting and Data System (BI-RADS) screening result of BI-RADS-3 are diagnosed more quickly and more often within 30 or 60 days of mammogram abnormality detection.

AB - BACKGROUND. Breast cancer is the leading cause of cancer-related deaths in Latinas, chiefly because of later diagnosis. The time from screening to diagnosis is critical to optimizing cancer care, yet the efficacy of navigation in reducing it is insufficiently documented. Here, the authors evaluate a culturally sensitive patient navigation program to reduce the time to diagnosis and increase the proportions of women diagnosed within 30 days and 60 days. METHODS. The authors analyzed 425 Latinas who had Breast Imaging Reporting and Data System (BI-RADS) radiologic abnormalities categorized as BI-RADS-3, BI-RADS-4, or BI-RADS-5 from July 2008 to January 2011. There were 217 women in the navigated group and 208 women in the control group. Women were navigated by locally trained navigators or were not navigated (data for this group were abstracted from charts). The Kaplan-Meier method, Cox proportional hazards regression, and logistic regression were used to determine differences between groups. RESULTS. The time to diagnosis was shorter in the navigated group (mean, 32.5 days vs 44.6 days in the control group; hazard ratio, 1.32; P =.007). Stratified analysis revealed that navigation significantly shortened the time to diagnosis among women who had BI-RADS-3 radiologic abnormalities (mean, 21.3 days vs 63.0 days; hazard ratio, 2.42; P <.001) but not among those who had BI-RADS-4 or BI-RADS-5 radiologic abnormalities (mean, 37.6 days vs 36.9 days; hazard ratio, 0.98; P =.989). Timely diagnosis occurred more frequently among navigated Latinas (within 30 days: 67.3% vs 57.7%; P =.045; within 60 days: 86.2% vs 78.4%; P =.023). This was driven by the BI-RADS-3 strata (within 30 days: 83.6% vs 50%; P <.001; within 60 days: 94.5% vs 67.2%; P <.001). A lack of missed appointments was associated with timely diagnosis. CONCLUSIONS. Patient-centered navigation to assist Latina women with abnormal screening mammograms appeared to reduced the time to diagnosis and increase rates of timely diagnosis overall. However, in stratified analyses, only navigated Latinas with an initial BI-RADS-3 screen benefited, probably because of a reduction in missed diagnostic appointments. Cancer 2013. © 2012 American Cancer Society. Patient-centered navigation to assist Latina women with abnormal screening mammograms appears to reduce the time to diagnosis and increase rates of timely diagnosis overall. However, results from stratified analysis indicate that only navigated Latinas with an initial Breast Imaging Reporting and Data System (BI-RADS) screening result of BI-RADS-3 are diagnosed more quickly and more often within 30 or 60 days of mammogram abnormality detection.

KW - BI-RADS

KW - breast cancer

KW - Breast Imaging Reporting and Data System

KW - health disparities

KW - Latinas

KW - patient navigation

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