Patient Navigation Programs Need to Address Gender, Race in Breast Cancer, Study Says

Black women are more likely to be diagnosed at a later stage of breast cancer in part due to barriers to timely screening mammography, a study reported, leading to a disparity in mortality and survival outcomes.

Patient navigation that helps to overcome barriers to the early detection of breast cancer is an effective intervention for reducing breast cancer disparities. However, the ability to recognize and seek help to overcome barriers may be affected by gendered and racialized social expectations of women, the study reported. Patient navigators are individuals who provide guidance to patients to help overcome barriers to care.

Learn more about clinical pathways in breast cancer.

The results indicate that such programs must consider how minority women's views on gender and race/ethnicity may affect how they seek help and support.Sage Kim, PhD, of the University of Illinois at Chicago's School of Public Health and UI Cancer Center, and her colleagues examined the rates at which women in a randomized clinical trial reported barriers to obtaining a screening mammogram.

The trial, called the Patient Navigation in Medically Underserved Areas study, randomly assigned patients to 1 of 2 groups. One group received a patient navigation support intervention and the other group served as a control.

Of the 3754 women who received the patient navigation intervention, only 14% identified 1 or more barriers, which led to additional interactions with navigators who helped overcome barriers. The study found that black women, women living in poverty, and women who reported high levels of distrust of the healthcare system were the least likely to report barriers and therefore were less likely to receive additional support.

Comparatively, women who reported barriers were more likely to have additional contact with navigators and obtain a subsequent screening mammogram.

“Our findings suggest that black women and women living in poverty, who need patient navigation interventions the most, are in fact less likely to report their barriers to optimal care,” Kim said in a statement. “Perhaps women who do not trust the health care system may not feel comfortable telling care providers about their barriers that could potentially affect the ways in which they engage in healthcare.”

The ability to recognize barriers may determine women's likelihood of reporting barriers and consequently receiving additional support. For example, medical distrust due to past and current experiences of black individuals, as well as social norms and images of women, may influence how black women deal with their own needs and interact with healthcare providers.

Kim said that although patient navigation is known to be effective, it is important to understand how minority women and women living in difficult life circumstances interact with this intervention and improve services accordingly.

If a patient does not report any barriers, it does not mean that none exist, the study said. Healthcare providers “may have a false sense of security,” she said. “They might incorrectly assume that women who do not report barriers are not in need of patient navigator support and are all doing well.”

Reference

Kim SJ, Glassgow AE, Watson KS, Molina Y, Calhoun EA. Gendered and racialized social expectations, barriers, and delayed breast cancer diagnosis [published online September 24, 2018]. Cancer. doi: 10.1002/cncr.31636.