Expanding access to cancer screening and clinical follow-up among the medically underserved

Blacks have the highest cancer incidences and mortality rates in the United States. Higher mortality rates appear due to higher incidence in some sites and to later-stage diagnoses in others. To address these problems, expanded cancer screening in an inner-city public hospital and a patient navigator intervention were proposed. Patient navigators acted as patient advocates for patients with abnormal screening findings. One thousand thirty-four females and 102 males were screened from July 1990 through November 1992; seven breast cancers and one cervical cancer were found. Patient navigators were significantly more likely to have seen patients with suspicious findings than patients with non-suspicious findings. However, even among those with suspicious findings, almost 70% were not seen by a patient navigator. Of those navigated, 87.5% completed recommended breast biopsies, compared with 56.6% of the non-navigated patients. Among those with a biopsy, navigated patients did so in significantly less time than those not navigated. Navigation is one of three phases proposed to reduce cancer mortality among medically underserved populations.