Patient navigators linked to higher rates of mammography for inner-city women

Women who are poor, uninsured, and belong to a minority group are less likely to get regular mammograms and more likely to die of breast cancer than their insured, white, and wealthier counterparts. New research from Boston Medical Center shows that screening mammogram rates can be improved among inner-city women if patient navigators help them overcome barriers to getting tested for early signs of breast cancer.

Dr. Karen Freund and her colleagues examined the use of patient navigators -- people who help patients find recommended care -- at three internal medicine practices serving mostly poor, minority women at Boston Medical Center. The 3,085 patients, who were from 51 to 70 years old and had not had a mammogram in at least 18 months, were divided into two groups at each practice.

One group got the usual care: Their doctors referred them for screening mammograms every other year, in line with recommendations for this age group. Women in the other group were contacted by patient navigators, who called them or sent them letters reminding them of their mammogram appointments. The navigators also asked why the women might not be able to keep their appointments and followed up if they didn’t. The navigators helped with transportation and interpretation services.

Before the study began, 75 percent of all the women got mammograms every other year. That’s below the 80 percent standard that national quality groups use to determine whether doctors are doing their part to encourage screening. In the Boston study, Hispanic women, who made up 11 percent of participants, were above that average, with mammogram rates of 85 percent. Freund, who is chief of the women’s health unit at Boston Medical Center, suspects that medical interpreters who work with Spanish-speaking women function like patient navigators, given their knowledge of the medical system.

After the nine-month study, mammogram rates rose to 87 percent among the women who worked with patient navigators. That compares to 76 percent among women in the comparison group.

“This to us is really exciting,” Freund said in an interview. “In a safety-net institution like ours, we can meet the standard, even given the extra barriers our patients face. I think this can serve as a model for lots of things we need to do, for other cancer screening care, diabetes care, heart disease prevention.”

The study, which appears online in the Journal of General Internal Medicine, and the patient navigators’ work were funded by a grant from the Avon Foundation Safety Net Grant. Safety-net hospitals care for a disproportionate share of patients who are poor, uninsured, or from racial or ethnic minority groups.