WASHINGTON — Low-income and minority women screened for breast cancer at Capital Breast Cancer Center (CBCC) in Washington, DC, exceed national standards in their rate of medical follow-up after a positive mammogram, according to a small study presented at the American Association for Cancer Research Annual Meeting 2013. Researchers credit CBCC patient navigators with playing a key role in ensuring high follow-up rates.
CBCC, a community-based arm of Georgetown Lombardi Comprehensive Cancer Center located in Southeast Washington, provides culturally sensitive breast cancer screening services, and health and wellness education guided by evidence-based practices to all women in the metropolitan area, regardless of their ability to pay. CBCC was established to help reduce health disparities in the nation's capital, where the death rate from breast cancer is higher than the rest of the nation.
This is despite a higher self-reported rate of cancer screening in the region. According to the DC Cancer Consortium, Washington residents report higher rates of breast cancer screening than do adults nationwide. Among women 50 to 74, 86.5 percent report having had a mammogram within the last two years, compared with 80 percent nationally.
"While screening rates appear strong, we were concerned that women weren't consistently coming back for a follow-up diagnostic mammogram if their initial mammogram was positive," says Bridget Oppong, MD, assistant medical director of CBCC. "We had observed anecdotally that women weren't showing up for their follow-up appointments. With our electronic health records, we were able to get a more accurate picture." Oppong is an assistant professor of medicine at Georgetown University School of Medicine and an attending physician at MedStar Georgetown University Hospital.
From January 2010 to December 2011, CBCC performed 2,430 digital screening mammograms. Of the women who reported their race (86 percent), nearly half (46 percent) identified themselves as black and 37 percent as Hispanic. Mammograms yielded an abnormal finding in 353 (15 percent) of all the women screened.
"Of the 353 women with an abnormal mammogram, 91 percent returned for the recommended follow-up appointment to receive a diagnostic mammogram," Oppong explained. "We are certainly pleased with that rate."
The median interval between screening and diagnostic imaging was 40 days. After diagnostic imaging, 34 women were recommended to have a core needle biopsy, of which 28 (82 percent) completed within a median of 19 days. The U.S. Centers for Disease Control and Prevention recommends a median of less than 60 days between an abnormal mammography result and a diagnosis.
Oppong and colleagues speculate that the high follow-up rate can be attributed to CBCC patient navigators. "The navigators establish very close relationships with women who have breast problems detected on imaging," she says. "The navigators remain connected with the women until the work-up is complete or until they have been referred for definitive treatment."
Oppong says further study is needed to understand the factors contributing to overall compliance in the screening for breast cancer. "The next obstacle remains getting women who have normal screening to return for routine screening in subsequent years."