Study: Intervention boosts mammo screening among minorities

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Patient navigation services can significantly improve biennial mammography rates for inner city, low income, minority populations, found a study published online Oct. 8 in the Journal of General Internal Medicine.

Lower mammography screening rates among minority and low income women contribute to increased morbidity and mortality from breast cancer, noted Christine E. Phillips, MD, from the women’s health unit at the Women’s Health Interdisciplinary Research Center at the Boston University School of Medicine, and colleagues.

The researchers evaluated a patient navigation intervention for biennial screening mammography among women in order to observe the effect it could have on adherence rates among women engaged in primary care at an inner-city academic medical center.

The study was conducted at Boston Medical Center between February 2008 to November 2008 and included 3,895 general internal medicine primary care practice female patients between the ages of 51-70. The participants were divided into two randomized groups, with 1,817 receiving the intervention and 2,078 receiving usual care.

The average age of the participants was 60 years. Approximately 71 percent consisted of racial/ethnic minorities and 23 percent were non-English speaking, with 63 percent having no public or health insurance, the authors offered.  

The participants in the intervention group whose last mammogram was greater than 18 months prior received a combination of two telephone calls and one reminder letter from patient navigators, explained Phillips and colleagues. The navigators were integrated into primary care teams and interacted directly with patients, providers and radiology staff to coordinate care. The participants were tracked via an electronic report by the navigators, and adherence rates for biennial mammography were assessed in both the intervention and control group at the start of the study and after intervention.

The researchers determined that at the start of the study, no difference was observed in mammography adherence between the control and intervention groups, with a participation level of approximately 78 percent. Following the nine-month intervention period, however, adherence among the intervention group rose to 87 percent versus 76 percent in the control group.

While all racial/ethnic and insurance groups demonstrated higher adherence in the intervention group at the end of the study period, Hispanic women demonstrated high rates in both the intervention and control groups, with participation of 85 percent compared to 83 percent, the authors wrote.

Phillips and colleagues noted that a subset of women remained non-adherent to mammography screening after the implementation of the intervention and the majority of these women were not reachable by phone or mail based on available contact information. “This reflects communication challenges in caring for an inner city, at-risk population and suggests a different approach is necessary for this group,” they said.

The findings support the benefit of patient navigation programs in the primary care setting as one approach to reduce cancer health disparities, noted the researchers.

“With the exception of Spanish speakers and the Hispanic population, who at baseline had high rates, the navigation intervention increased adherence across all ages, insurance groups, education levels and all other languages and races,” the study concluded.