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J Public Health Manag Pract. 2013 Sep-Oct;19(5):461-7. doi: 10.1097/PHH.0b013e318276e272.

Reducing barriers to breast cancer care through Avon patient navigation programs.

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Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-07, Atlanta, GA 30333, USA.



Avon Foundation for Women grantees provide breast cancer services through patient navigation (PN) in an effort to alleviate barriers to care among underserved women.


To gain a better understanding of how PN programs function, this study explores variations in the use of navigators, types of services offered, description of clients they serve, tracking of treatment completion, and evaluation mechanisms.


Fifty-six Avon PN programs funded since 2008 throughout the United States were contacted.


An online survey was distributed to the grantees of which 44 (81%) complete responses were collected and analyzed.


Clients were racially and ethnically diverse, mostly in the 40- to 64-year old age range (64%) and 91.6% with an average income of less than $30 000. Women were either uninsured (50.7%) or receiving Medicaid (32.4%). PN programs were both community and hospital-based (22.5%); many hospitals (35.2%) were described as safety nets (eg, provide a significant level of care to low-income, uninsured, vulnerable populations). On-site services included breast screening (eg, mammography and breast ultrasound) and treatment (eg, breast surgery and radiation therapy). Some barriers to care identified by the programs included transportation, access to appointments, language, and financial issues (eg, cost of screening and treatment specifically for those uninsured). More than 39% of programs provided care across the cancer continuum.


Many Avon PN programs incorporated navigation services that span the cancer care continuum. They addressed disparities by offering navigation and on-site medical services to reduce multiple systems barriers and social issues related to breast care.

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