The Impact of Navigation The Impact of Navigation Services for Breast and Cervical Services for Breast and Cervical Cancer Screening for Spanish-Cancer Screening for Spanish-

speaking Immigrant Latinasspeaking Immigrant Latinas

Lina Jandorf Lina Jandorf Mount Sinai School of Medicine Mount Sinai School of Medicine

New York CityNew York CityBridging the Health Care DivideBridging the Health Care Divide

April 19, 2007April 19, 2007

Co-AuthorsCo-Authors

LeaVonne Pulley - University of Arkansas for LeaVonne Pulley - University of Arkansas for Medical SciencesMedical Sciences

Michelle Trevino - University of Arkansas for Medical Michelle Trevino - University of Arkansas for Medical SciencesSciences

Luisa Feliciano – Mount Sinai School of MedicineLuisa Feliciano – Mount Sinai School of MedicineDeborah Erwin – Roswell Park Cancer InstituteDeborah Erwin – Roswell Park Cancer Institute

Topics to be Covered TodayTopics to be Covered Today

Latinas in the United StatesLatinas in the United States

Breast CancerBreast Cancer

Esperanza y VidaEsperanza y Vida

Where we are goingWhere we are going

Latinas in the United StatesLatinas in the United States

Fastest growing immigrant group in the USFastest growing immigrant group in the US

Over 20 different countries of OriginOver 20 different countries of Origin

Different Methods of ImmigrationDifferent Methods of Immigration– Puerto RicanPuerto Rican– MexicanMexican– DominicansDominicans

Breast Cancer and LatinasBreast Cancer and Latinas

Most common cancer among LatinasMost common cancer among Latinas– Lower incidence compared to White womenLower incidence compared to White women

Diagnosed at later stage Diagnosed at later stage – More metastatic diseaseMore metastatic disease

Lower rates of screeningLower rates of screening– E.g. Mammography use is lowerE.g. Mammography use is lower

Even greater for recent immigrantsEven greater for recent immigrants

Reasons for Underutilization of Reasons for Underutilization of ScreeningScreening

Access to CareAccess to Care– Insurance Insurance – Immigration StatusImmigration Status

AcculturationAcculturation

LanguageLanguage

Fatalistic BeliefsFatalistic Beliefs

FearFear– Both of finding cancer and deportationBoth of finding cancer and deportation

Esperanza y VidaEsperanza y Vida

Esperanza y VidaEsperanza y Vida

““Familias Saludables Empiezan con Mujeres Familias Saludables Empiezan con Mujeres Saludables”Saludables”

““Healthy Families begin with Healthy Healthy Families begin with Healthy Women”Women”

Study DesignStudy Design

Educational ProgramsEducational Programs– Rural / Urban sitesRural / Urban sites– New York City and ArkansasNew York City and Arkansas

Two study conditionsTwo study conditions– Breast and Cervical Cancer ScreeningBreast and Cervical Cancer Screening– DiabetesDiabetes

Pre and Post Test KnowledgePre and Post Test Knowledge

2-Month Follow Up Telephone Call2-Month Follow Up Telephone Call

Patient NavigationPatient Navigation

Program ComponentsProgram Components

Role ModelRole Model– Breast Cancer SurvivorBreast Cancer Survivor– Living well with DiabetesLiving well with Diabetes

Lay Health EducatorsLay Health Educators– FactsFacts– Screening GuidelinesScreening Guidelines– Risk FactorsRisk Factors

Key Program ElementsKey Program ElementsFaith based programFaith based program

Family, including extended familyFamily, including extended family

Address Medical MistrustAddress Medical Mistrust

Address FatalismAddress Fatalism

Address Access to CareAddress Access to Care

FindingsFindings

Program conducted November 2005 Program conducted November 2005 through November 2006through November 200665 Programs Completed65 Programs Completed– 35 in Arkansas and 30 in NYC35 in Arkansas and 30 in NYC– 40 on Cancer and 25 on Diabetes40 on Cancer and 25 on Diabetes

653 Participants – Per program653 Participants – Per program– 11.3 (0.2) overall (range of 2 to 50)11.3 (0.2) overall (range of 2 to 50)

8.1 (6.6) Females8.1 (6.6) Females3.2 (4.3) Men3.2 (4.3) Men

FindingsFindingsCountry of OriginCountry of Origin Years in the Years in the

USUSRangeRange

Mexico (51% of Mexico (51% of sample)sample)

8.3 (6.3)8.3 (6.3) LT 6 months – LT 6 months – 64 years64 years

Dominican Republic Dominican Republic (12%)(12%)

17.4 (9.7)17.4 (9.7) LT 6 months – LT 6 months – 35 years35 years

Puerto Rico (7%)Puerto Rico (7%) 30.6 (12.9)30.6 (12.9) 2-53 years2-53 years

Central America Central America (13%)(13%)

11.7 (8.5)11.7 (8.5) 1-35 years1-35 years

South America (11%)South America (11%) 14.8 (11.5)14.8 (11.5) 1-40 years1-40 years

Pre/Post Knowledge at BaselinePre/Post Knowledge at Baseline

Pre ScorePre Score Post ScorePost Score

Diabetes Diabetes KnowledgeKnowledge

39.0439.04

42.4042.40

81.4881.48

46.7746.77

Cervical Cancer Cervical Cancer KnowledgeKnowledge

52.0152.01

58.6458.64

56.3356.33

76.8876.88

Breast Cancer Breast Cancer KnowledgeKnowledge

44.4444.44

46.7746.77

47.5347.53

72.1972.19

1st line = Diabetes Programs

2nd line = Cancer Programs

2 Month Follow Up Data2 Month Follow Up Data

235 Women235 Women

– 119 Under 40119 Under 40– 98 40 Plus98 40 Plus– 18 Missing Age18 Missing Age

Cancer ScreeningCancer Screening

Diabetes Diabetes ProgramProgram

Cancer Cancer ProgramProgram

Clinical Breast Clinical Breast ExamExam

48% completed 48% completed at follow upat follow up

83%83%

MammographyMammography

(women 40 plus)(women 40 plus)

78%78% 83%83%

Breast Self ExamBreast Self Exam 50%50% 88%88%

Pap ExamPap Exam 39%39% 71%71%

Refers to women who were non-adherent at baseline

ImplicationsImplications

Use of navigatorsUse of navigators– BilingualBilingual– From the communityFrom the community

How to sustain these increases?How to sustain these increases?

How to increase reach of the programs?How to increase reach of the programs?

Future DirectionsFuture Directions

What are the factors related to the What are the factors related to the baseline screening ratesbaseline screening rates– Knowledge pre programKnowledge pre program– Country of OriginCountry of Origin– AgeAge– Years in the USYears in the US

Future DirectionsFuture Directions

What predicts who gets screened within 2 What predicts who gets screened within 2 months?months?– Knowledge post programKnowledge post program– Country of OriginCountry of Origin– AgeAge– Years in the USYears in the US– Marital StatusMarital Status– Partner at ProgramPartner at Program

AcknowledgementsAcknowledgements

National Susan G. Komen Breast Cancer National Susan G. Komen Breast Cancer Foundation –Grants #POP 0201290 and Foundation –Grants #POP 0201290 and #POP 0503950#POP 0503950

Mount Sinai School of MedicineMount Sinai School of Medicine

University of Arkansas Medical CenterUniversity of Arkansas Medical Center

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