From Breast Cancer Screening to Definitive Diagnosis: Strategies for Successfully Serving the Underserved

Background: Uninsured patients receive half the care of their insured counterparts, leading to poorer health outcomes as a result of delayed diagnoses. Breaks in cancer care impact survival rates and quality of life. The Seton Healthcare Family, the only National Cancer Institute Community Cancer Centers Program (NCCCP) site in the Southwest, has provided breast cancer care spanning the full cancer continuum to low-income and uninsured women across central Texas since 1987.

Objectives: This presentation discusses Seton’s successful efforts to expand culturally appropriate breast cancer outreach to high-risk, diverse, and underserved women residing in central Texas and focus on factors supporting navigation of women with an abnormal screening result to definitive diagnosis in a timely manner with a lost-to-follow-up rate less than 1%. Methods: Seton’s mobile mammography program, with support from Komen for the Cure—Austin and the National Breast Cancer Foundation, couples screening mammography with breast health education and clinical breast exam by specially trained registered nurses. By offering culturally appropriate, free breast services in partnership with respected community sites, Seton provides accessible services to underserved women in their communities. Women with abnormal results are navigated to definitive diagnosis by the same screening nurse. Detailed protocols and breast diagnostics funding facilitate compliance with diagnostic testing. Multiple reminder efforts encourage yearly screening participation per national guidelines.

Results: From April 1, 2010, to March 31, 2011, 1828 women were screened at 121 sites in 7 federally designated medically underserved counties, with 56% of participants Hispanic, 26% non-Hispanic Caucasian, 13% Asian, and 5% African American. In total, 203 women had an abnormal result, and all were navigated to a definitive diagnosis. Grants covered costs of nearly 700 diagnostic procedures and more than 300 physician office visits. Women progressed from abnormality detection to definitive diagnosis in an average of 24 days. The program also averages a 38% screening return rate over the past 5 years.

Conclusions: Seton’s breast cancer screening program is a community-centric initiative focused on long-term health behavior changes based on trust developed through community linkages, removal of financial barriers, effective processes, and consistent relationships between clients and skilled nurse navigators. As a result of the success of this screening model, Seton has developed programs replicating that same model for other types of disease-specific screenings (cervical and skin) for high-risk underserved populations. Seton’s model has been shared with other NCCCP sites and is replicable by other organizations.