title: Effects of an outreach and internal navigation program on breast cancer diagnosis in an urban cancer center with a large African-American population.
abstract: BACKGROUND
  Compared with white women, African-American (AA) women who are diagnosed with breast cancer experience an excess in mortality. To improve outcomes, the authors implemented community education and outreach initiatives in their cancer center, at affiliated primary care sites, and in the surrounding communities. They then assessed the effectiveness of these outreach initiatives and internal patient navigation on stage of diagnosis.
  
  
  METHODS
  This cross-sectional study was an analysis of all women with breast cancer who were diagnosed and/or treated in the years from 2001 through 2004. The outreach initiatives were implemented in 2001; 125 trained Community Health Advocates (CHAs) provided educational programs to the community, and Patient Navigators communicated directly with patients to encourage screening, diagnostic procedures, and treatment.
  
  
  RESULTS
  In total, 487 patients were diagnosed/treated from 2001 through 2004. Since 2001, there were 1148 community interventions by CHAs with an estimated program attendance of >10,000 participants. In the interval from 2001 through 2004, the proportion of stage 0 (in situ) breast cancers increased from 12.4% (n = 14) to 25.8% (n = 33; P < .005), and there was a decline in stage IV invasive breast cancers from 16.8% (n = 19) to 9.4% (n = 12; P < .05).
  
  
  CONCLUSIONS
  The outreach initiatives and internal patient navigation appear to have improved stage at diagnosis. To determine whether specific patients presented earlier as a result of specific community outreach initiatives, prospective work is underway to measure the effects of these interventions on potential stage migration. Similarly, prospective data are being collected to determine whether Patient Navigators influence treatment and appointment adherence as well as the underlying reasons for barriers to specific interventions in this underserved minority population.
authors.affiliation: Georgia Cancer Center for Excellence at Grady Health System, Emory University School of Medicine, Atlanta, Georgia 30322, USA. sgabram@emory.edu
authors.forename: Sheryl G A
authors.initials: SG
authors.lastname: Gabram
authors.forename: Mary Jo B
authors.initials: MJ
authors.lastname: Lund
authors.forename: Jessica
authors.initials: J
authors.lastname: Gardner
authors.forename: Nadjo
authors.initials: N
authors.lastname: Hatchett
authors.forename: Harvey L
authors.initials: HL
authors.lastname: Bumpers
authors.forename: Joel
authors.initials: J
authors.lastname: Okoli
authors.forename: Monica
authors.initials: M
authors.lastname: Rizzo
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Johnson
authors.forename: Gina B
authors.initials: GB
authors.lastname: Kirkpatrick
authors.forename: Otis W
authors.initials: OW
authors.lastname: Brawley
mesh_terms: D001741:Black or African American / Q000193:education* / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000473:pathology; D019058:Community Networks; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006266:Health Education / Q000379:methods*; D006297:Health Services Accessibility; D006786:Hospitals, Urban; D006801:Humans; D008403:Mass Screening; D008495:Medical Oncology; D009367:Neoplasm Staging; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data