A new study indicates that community education outreach and internal navigation programs lead to a significant shift in stage at diagnosis of breast cancer among African American women, with a doubling in the proportion of cases caught at the earliest stage and a nearly reciprocal drop in the proportion of cancers at most advanced stage.
The research suggests that initiatives aimed at raising awareness and utilization of breast cancer screening may improve breast cancer survival rates for African American women, who have a higher risk of death from the disease compared to whites. The study is published in the August 1, 2008 issue of CANCER, a peer-reviewed journal of the American Cancer Society.
A disproportionate number of deaths from breast cancer occur in African American women, a disparity attributed to later stage of disease at diagnosis and diagnosis at an earlier age. Treatment differences may also contribute to the higher risk of mortality.
To assess the effectiveness of outreach programs on breast cancer stage among African American women, Sheryl Gabram, M.D., an Emory University surgical oncologist and director of the AVON Comprehensive Breast Center at the Georgia Cancer Center for Excellence at Grady Memorial Hospital in Atlanta, reported on a program implemented in 2001 with two components: Community Health Advocacy and Patient Navigation. The Community Health Advocacy component includes public educational programs that encourage mammography screening, teach the importance of breast self exams, and instruct individuals to see a trained healthcare provider. The Patient Navigation component involves breast cancer survivors who communicate directly with all patients who have been diagnosed with breast cancer in the AVON Breast Center. Patient Navigators (PNs) encourage patients to follow-up with recommended medical care and access needed resources such as finances, transportation, and support services.
Between 2001 and 2004, the program conducted a total of 1,148 community interventions for more than 10,000 participants. During that same time period, a total of 487 patients were identified, diagnosed, and treated for breast cancer at the AVON Comprehensive Breast Center (89 percent African American, 5 percent Caucasian, 2 percent Hispanic, and 4 percent other race/ethnicity). Dr. Gabram and her team found that there was a doubling in the proportion of Stage 0 non-invasive breast cancers (from 12.4 percent to 25.8 percent) over the study period, while the proportion of women diagnosed with Stage IV invasive breast cancers dropped from 16.8 percent to 9.4 percent.