Patient navigation leads to increased rates of timely definitive diagnosis in Latinas with BIRADS-3 breast abnormalities –The Six Cities Study

Abstract: BACKGROUND: Our controlled patient navigation trial in Latinas from six U.S. cities showed that navigated Latinas with BIRADS-3 abnormal screens achieve definitive diagnosis significantly faster than their non-navigated counterparts. Here we explore whether increased efficacy in diagnosis through navigation is clinically meaningful and why. METHODS: Based on CDC standards we identified a period of 60 days within the date of initial breast cancer screening as “timely definitive diagnosis” in 133 women from the larger Six Cities Study with abnormal breast screens radiologically classified as BIRADS-3. We compared navigated versus non-navigated Latinas using chi-squared and multiple logistic regression analysis, and hierarchical multiple logistic regression to determine clinic and patient-level measures explaining timely diagnosis. RESULTS: 133 Latinas were classified as BIRADS-3. There were no significant group differences in demographic measures. Significantly more navigated than non-navigated Latinas achieved timely diagnosis (94.5% versus 71.7%, p=.001 when the 6-month waiting period was controlled). This statistical difference remained (p=.022) after controlling for clinical characteristics (% Hispanic patients, uninsured patients, Birads-3 screens, and a high-tech index; all p<.05). Fewer BIRADS-3 Latinas missed scheduled appointments (11.6% v. 23.8%, p=.047) or were lost to follow-up (3.3% versus 10.7%, p=.042). Fewer missed appointments explains some, but not all of the navigation affect. CONCLUSIONS: Patient-centered navigation increases timely diagnosis in Latinas with a BIRADS-3 result. This increase exceeds the CDC standard for acceptable rates of timely diagnosis (75%) in abnormal breast screening by approximately 26%. The increased rate has significant benefits including fewer missed appointments and lower group attrition rates.