AIM: Case management improves time to diagnosis of breast cancer

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Case management can improve the time to diagnosis of breast cancer for low income, underinsured women, according to an article published in the March 22 issue of the Archives of Internal Medicine.

Rebecca Lobb, ScD, MPH, of the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, and colleagues studied 2,252 women who participated in the National Breast and Cervical Cancer Early Detection Program (BCCEDP) in Massachusetts from 1998 through 2007. The BCCEDP funds breast cancer screening and diagnostic services for low-income, underinsured women.

According to the authors, starting July 1, 2001, all Massachusetts BCCEDP clients with a mammogram result of Breast Imaging Reporting and Data System (BI-RADS) 4 (suspect abnormality) or 5 (highly suggestive of malignant neoplasm) were offered case management. Starting in 2004, all BCCEDP participants diagnosed with breast cancer were eligible for free treatment.

The authors looked at two outcome measures of delay—diagnostic delay and treatment delay. Among women in the program, those experiencing a delay before diagnosis decreased from 33 percent to 23 percent after case management was implemented—a risk reduction of 45 percent that didn’t change according to race or ethnicity.

However, the authors did find that the free treatment policy "was not associated with timeliness of diagnostic resolution or initiation of treatment beyond improvements observed after implementation of case management." The authors did suggest that the greatest benefit to the free treatment policy "may be found in outcomes not measured in this study, such as improved receipt of treatment sessions, reduced anxiety and mitigation of the financial burden of cancer treatment."

"Case management to assist women in overcoming logistic and psychosocial barriers to care may improve time to diagnosis among low-income women who receive free breast cancer screening and diagnostic services," the authors concluded. "Programs that provide services to coordinate care, in addition to free screening and diagnostic tests, may improve population health."