Local Services Navigation to Improve Breast Cancer Screening Outcomes

Persistent differences in breast cancer outcomes can be largely attributed to gaps in follow-up care after breast cancer screening. While U.S. breast cancer mortality rates have declined by approximately 2% per year since 1990, certain population segments have experienced rising mortality rates during the same period. Many of these deaths are preventable. Mammography is a proven screening method that, when paired with timely and appropriate follow-up care, improves outcomes for millions each year. Various services are available to support breast cancer screening. However, to improve outcomes, it is essential to address ongoing limitations to follow-up after abnormal screening results. Women experiencing greater support limitations (e.g., food, housing, utilities, transportation) are approximately half as likely to complete follow-up after an abnormal mammogram compared to those with fewer such limitations. There is a pressing need to implement programs that help women overcome these obstacles, including improving access to local resources. The SINCERE intervention, a validated screening and referral process for addressing basic support limitations, has been shown in previous studies to be feasible and acceptable in Emergency Department settings. Building on this work, we propose to adapt and expand the intervention by adding non-clinical service navigation, an active outreach approach to connect patients with needed local services. This effort aims to enhance follow-up care for individuals with abnormal breast screening results. The primary goal of this study is to evaluate whether adding non-clinical service navigation to the standard referral process is an effective and scalable strategy for improving follow-up care. By working with statewide service providers, leveraging existing health information technology, and using validated methods, we will assess the effectiveness of this combined approach in improving outcomes in the breast cancer screening setting. We anticipate that outreach to women who are less likely to receive timely follow-up will lead to improved screening outcomes and help reduce the number of late-stage breast cancer diagnoses.