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Cancer Epidemiol Biomarkers Prev. 2010 Aug;19(8):1927-36. doi: 10.1158/1055-9965.EPI-09-0481. Epub 2010 Jul 20.

Low-income women with abnormal breast findings: results of a randomized trial to increase rates of diagnostic resolution.

Author information

  • 1School of Public Health, Division of Cancer Prevention and Control Research, University of California-Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA. bastani@ucla.edu

Abstract

BACKGROUND:

Timely diagnostic resolution of abnormal breast findings represents a critical step in efforts to reduce breast cancer morbidity and mortality. Yet, follow-up rates among resource poor populations are not optimal. Efforts to mitigate this disparity are needed. We report results of a randomized trial assessing the effectiveness of a patient support and navigation intervention in increasing timely diagnostic resolution of abnormal breast findings among indigent women.

METHODS:

Women (n = 1,708) diagnosed with a breast abnormality at two public hospitals were randomized to an intervention or control group. The intervention, delivered through telephone, involved one call from a professional health worker and multiple calls from a lay health worker. The outcome, timely diagnostic resolution, defined as receipt of a definitive diagnosis (malignant or benign) within 6 months of the index referral, was assessed through medical chart audit.

RESULTS:

Intent-to-treat analyses revealed no significant effect of the intervention on timely diagnostic resolution. Diagnostic resolution rates were 55% and 56%, respectively, in the intervention and control arms. The significant predictors were method of abnormality identification (odds ratio = 1.50) and location of first scheduled appointment (odds ratio = 0.62).

CONCLUSIONS:

The intervention was not effective in creating change within the County health system. Achieving optimum diagnostic follow-up may require more intensive interventions than the one tested. In addition, system-level rather than patient-level interventions may hold more promise.

IMPACT:

There are no randomized trials reported in the literature testing interventions to increase diagnostic follow-up of breast abnormalities. Future research might test patient and system-level interventions that can be sustained beyond the study period.

(c)2010 AACR.

PMID:
20647406
[PubMed - indexed for MEDLINE]
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