Decreasing Disparities in Breast Cancer Screening in Refugee Women Using Culturally Tailored Patient Navigation

J Gen Intern Med. 2013 Nov;28(11):1463-8. doi: 10.1007/s11606-013-2491-4. Epub 2013 May 18.


Background: Patient navigator (PN) programs can improve breast cancer screening in low income, ethnic/racial minorities. Refugee women have low breast cancer screening rates, but it has not been shown that PN is similarly effective.

Objective: Evaluate whether a PN program for refugee women decreases disparities in breast cancer screening.

Design: Retrospective program evaluation of an implemented intervention.

Participants: Women who self-identified as speaking Somali, Arabic, or Serbo-Croatian (Bosnian) and were eligible for breast cancer screening at an urban community health center (HC). Comparison groups were English-speaking and Spanish-speaking women eligible for breast cancer screening in the same HC.

Intervention: Patient navigators educated women about breast cancer screening, explored barriers to screening, and tailored interventions individually to help complete screening.

Main measures: Adjusted 2-year mammography rates from logistic regression models for each calendar year accounting for clustering by primary care physician. Rates in refugee women were compared to English-speaking and Spanish-speaking women in the year before implementation of the PN program and over its first 3 years.

Results: There were 188 refugee (36 Somali, 48 Arabic, 104 Serbo-Croatian speaking), 2,072 English-speaking, and 2,014 Spanish-speaking women eligible for breast cancer screening over the 4-year study period. In the year prior to implementation of the program, adjusted mammography rates were lower among refugee women (64.1 %, 95 % CI: 49-77 %) compared to English-speaking (76.5 %, 95 % CI: 69 %-83 %) and Spanish-speaking (85.2 %, 95 % CI: 79 %-90 %) women. By the end of 2011, screening rates increased in refugee women (81.2 %, 95 % CI: 72 %-88 %), and were similar to the rates in English-speaking (80.0 %, 95 % CI: 73 %-86 %) and Spanish-speaking (87.6 %, 95 % CI: 82 %-91 %) women. PN increased screening rates in both younger and older refugee women.

Conclusion: Linguistically and culturally tailored PN decreased disparities over time in breast cancer screening among female refugees from Somalia, the Middle East and Bosnia.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / ethnology*
  • Cultural Characteristics
  • Early Detection of Cancer / methods
  • Early Detection of Cancer / trends*
  • Female
  • Healthcare Disparities / ethnology*
  • Healthcare Disparities / trends*
  • Humans
  • Mammography / methods
  • Mammography / trends
  • Middle Aged
  • Patient Navigation / methods
  • Patient Navigation / trends*
  • Refugees*
  • Retrospective Studies