title: A Multi-faceted Approach to Improving Breast Cancer Outcomes in a Rural Population, and the Potential Impact of Patient Navigation.
abstract: The mastectomy rate in rural areas of the Northern Plains of the U.S. was 64 percent from 2000 through 2005. We implemented a breast cancer patient navigation (BPN) program in May 2007 to increase breast conservation (BC) rates.
  
  
  METHODS
  We analyzed mastectomy and BC rates among our 1,466 patients with either ductal carcinoma in situ (DCIS) or stage I/II invasive breast cancer treated from 2000 through 2012. We used interrupted time series (ITS) to compare rates in treatment following implementation of BPN. In addition, breast conservation rates were compared to population data from the Surveillance, Epidemiology, and End Results (SEER) database.
  
  
  RESULTS
  The BC rates were 56 percent for navigated patients versus 37 percent for non-navigated patients (95 percent CI for difference: 14.8 to 25.6 percent). There was a consistent annual increase in treatment with BC versus a mastectomy (+2.9 percent/year, p-trend < 0.001). The BC rate of 60 percent in 2012 now mirrors those observed in the SEER database. The ITS did not find that the change in BC rates over time was significantly attributable to implementation of the BPN. Other secular trends may have contributed to the change in BC rates over time.
  
  
  CONCLUSIONS
  A number of factors may have contributed to an increase of BC rates over time, including physician and patient education, more radiation therapy options, and possibly a dedicated breast cancer PN program. This analysis demonstrates that overall breast cancer care among this rural and medically-underserved population is improving in our region and now parallels other regions of the country.
authors.forename: Daniel
authors.initials: D
authors.lastname: Petereit
authors.forename: Adam
authors.initials: A
authors.lastname: Omidpanah
authors.forename: Amy
authors.initials: A
authors.lastname: Boylan
authors.forename: Patricia
authors.initials: P
authors.lastname: Kussman
authors.forename: Denise
authors.initials: D
authors.lastname: Baldwin
authors.forename: Deborah
authors.initials: D
authors.lastname: Banik
authors.forename: Mary
authors.initials: M
authors.lastname: Minton
authors.forename: Eric
authors.initials: E
authors.lastname: Eastmo
authors.forename: Paul
authors.initials: P
authors.lastname: Clemments
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments / Q000379:methods / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D062526:Patient Navigation / Q000379:methods / Q000458:organization & administration; D015397:Program Evaluation; D019035:Rural Health Services / Q000706:statistics & numerical data; D012424:Rural Population; D013023:South Dakota / Q000453:epidemiology