Dr Welman on the Effects of Patient Navigation on Breast Cancer Screening and Diagnosis

“We reduced the time from [screening] order to cancer diagnosis.”

Martha Welman, MD, chief medical officer at Neighborhood Health, discussed findings from a strategic breast cancer screening initiative aimed at reducing diagnostic disparities among underserved and low-income populations.

The study authors emphasized that patients served by the federally qualified health center that was the focus of the study often face significant socioeconomic barriers to care, including limited English proficiency, transportation challenges, and low health literacy. These obstacles have historically led to protracted delays in the screening-to-diagnosis continuum, frequently resulting in patients presenting with late-stage malignancies.

To address these delays, Welman and colleagues implemented a comprehensive patient navigation program and systemic process improvements. The methodology involved hiring additional bilingual patient navigators to provide one-to-one support, implementing standing orders for clinical staff, and utilizing bi-directional texting for patient reminders. Furthermore, the project expanded imaging access through partnerships with radiology providers and the deployment of a mobile mammography van. Welman noted that prior to these interventions, the time from an initial screening order to a final cancer diagnosis often exceeded 6 months.

The analysis of project data from April 2024 to August 2025 demonstrated significant reductions across every stage of the diagnostic pathway. Welman highlighted that the average time for screening mammogram order completion decreased by 48%, falling from 79 days in 2023 to 41 days in 2025. The average interval between exam recall and follow-up imaging saw a 51% reduction, from 59 days to 29 days, whereas the average time from diagnostic referral to completion decreased by 47%, from 62 days to 33 days. Additionally, the average time required for biopsy completion dropped 48% in a single year, moving from 40 days in 2024 to 21 days in 2025.

A primary clinical objective was the reduction of late-stage diagnoses, which decreased from 23.3% (n = 7) in 2023 to 7.4% (n = 2) in 2024. The authors observed that although the odds of a late-stage diagnosis were approximately 3.8 times higher before the implementation of these interventions, the small sample size—30 cancers in the baseline year and 27 cancers in the next year—meant the results did not reach statistical significance (P = .15).

Looking ahead, Welman raised the importance of determining whether these benefits are sustained over the long term. The project’s future focus will shift toward targeting high-risk populations, specifically patients with genetic or family history risk factors who may require screenings before the age of 40 years. The central goal remains the expansion of navigation and system-wide improvements to ensure rapid linkage from referral to treatment for patients.