Initiatives Lead to Shift in Stage of Breast Cancer Diagnosis in African-American Women

Sheryl G. A. Gabram, MD, MBA. Professor of Surgery, Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine. Program Director, Breast Surgical Oncology Fellowship, Winship Cancer Institute, Emory University. Director, AVON Comprehensive Breast Center, Grady Health System. Director, Oncologic Services, Georgia Cancer Center of Excellence, Grady Health System. Division of Surgical Oncology

Researchers at Emory University have determined that community education outreach and internal navigation programs lead to a significant shift in stage at diagnosis of breast cancer among African-American women. Sheryl Gabram, MD, an Emory Winship Cancer Institute surgical oncologist, and her colleagues report 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 in African-American women who participated in community education or internal navigation programs. 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 on line this month and 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, Dr. Gabram, who also is 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.

"This reciprocal deviation of Stage 0 versus Stage IV cancers has implications on prognosis, and ultimately outcome for these women if recommended treatment guidelines are followed," say the authors. They, along with leadership from Emory University's Rollins School of Public Health team, are currently conducting studies to see if the Patient Navigation program successfully influences patients to accept treatment recommendations and to adhere to appointments after they are diagnosed with breast cancer. Research has revealed that many patients with breast cancer refuse or do not receive appropriate therapy.

The authors concluded that programs with Community Health Advocates (CHAs) who encourage mammography screening and stress the importance of early diagnosis should be jointly emphasized with the efforts of the Patient Navigators (PNs) who encourage acceptance of and adherence to treatment standards.

Article: "Effects of an outreach and internal navigation program on breast cancer diagnosis in an urban cancer center with a large African-American population." Sheryl G.A. Gabram, Mary Jo B. Lund, Jessica Gardner, N adjo Hatchett, Harvey L. Bumpers, Joel Okoli, Monica Rizzo, Barbara J Johnson, Gina B Kirkpatrick, and Otis W. Brawley. CANCER; Published Online: June 23, 2008 (DOI: 10.002/cncr.23568); Print Issue Date: August 1, 2008.