Navigating Under-served Women to Better Breast Health: A national model for health disparity policy development

Background: Memphis, TN is the city with the largest disparity in breast cancer mortality rates between non-Hispanic Black and non-Hispanic White women.  Memphis, which is predominantly black, has a 20% poverty level and a dismal uninsured rate despite efforts to expand coverage under the Affordable Care Act and recent failure to adopt “Insure Tennessee,” a proposal to extend coverage to 200,000 uninsured Tennesseans who earn less than 138 percent of the federal poverty level (FPL) advanced by Governor Haslam in a special session of the Tennessee Legislature.

Methods: Through a cooperative partnership between the Methodist Le Bonheur Healthcare System and West Cancer Center, we utilized the Congregational Health Network (CHN) and a Community Outcome and Relations Coordinator (CORC) to seamlessly transition participants from the community to the clinic. The CHN is comprised of 8 patient navigators and over 600 trained liaisons.

Results: From September 2014 to January 2015, 559 eligible women were initially contacted.  325 women have been screened—222 screening and 103 diagnostic mammograms. Our estimated adherence rate (patients who showed interest who obtained a screening exam) was 82%.  This resulted in a 5.8% call back biopsy rate (19/325), 15 of which have been completed.  Two malignant lesions have been detected. 152 patients were still pending call back for screening.  67% of women were black, 29% Hispanic and 1% white.  77% of women were between the ages of 40-60 years.

Conclusion: We have described and successfully replicated a community-based outreach model for breast cancer navigation.