Dedicated, personalized patient navigation serves are high-value investments that can overcome literacy and resource barriers to accelerate the transition from breast cancer screening to diagnosis and reduce rates of late-stage cancer diagnoses, according to Martha Welman, MD.
Welman and colleagues conducted a study evaluating the effects of various patient navigation services on time to breast cancer screening and diagnosis at Neighborhood Health, a Federally Qualified Health Center in Alexandria, Virginia. They found that with these services, the average time from mammogram order to completion decreased by 48%, from 79 days in 2023 to 41 days in 2025.1
“An important outcome was this quicker time from the time [a patient got] screening to their call back to biopsy,” Welman said in an interview with OncLive® during the 2025 San Antonio Breast Cancer Symposium.
Additionally, the time from exam recall to follow-up imaging decreased by 51%, from 59 days in 2023 to 29 days in 2025. The time between diagnostic referral and completion decreased by 47%, from 62 days to 33 days in these respective years. Furthermore, the time to biopsy completion decreased by 48%, from 40 days in 2024 to 21 days in 2025. The percentage of late-stage cancer diagnoses also decreased from 23.3% in 2023 to 7.4% in 2025 (P = .15).
In the interview, Welman discussed the rationale for this research, key findings, and future plans, which include targeting high-risk patients for early screening and monitoring the benefits of these efforts over time. She also emphasized the value of personalized patient relationships over technology, especially for populations with limited access to digital resources.
Welman is chief medical officer of Neighborhood Health.
Prefer to watch? Check out our video series highlighting some of the insights from this interview.2
OncLive: Why is investigating ways to broaden access to patient navigation services within the breast cancer treatment field relevant?
Breast Cancer Patient Navigation Effects on Time to Screening and Diagnosis: Highlights
- Patient navigation and system-wide disparity reduction improvements reduced delays across several stages of the breast cancer screening and diagnostic pathway for underserved populations.
- This initiative achieved substantial time savings, including a 48% decrease in the average time from a screening mammogram order to its completion.
- By streamlining the diagnostic process, investigators saw a meaningful clinical trend where late-stage breast cancer diagnoses decreased from 23.3% in 2023 to 7.4% in 2024.
Welman: [This research is] focused on reaching hard-to-reach, low-literacy, low-income, poorly insured patients who need breast cancer screening services.1 This topic came to light after the COVID-19 pandemic, when we saw an increase in our population having late-stage breast cancer diagnoses, particularly in younger women. We wanted to improve access to screening for this difficult-to-reach population.
How was this analysis of breast cancer screening services designed?
We used a multi-pronged intervention focused on reducing the time to cancer diagnosis and hopefully reducing the incidence of late-stage cancer. Many patients who have to navigate the complex web of breast cancer screening and diagnosis are unable to do that successfully on their own. We provided one-to-one navigation with navigators who are bilingual for our non-English–speaking patients to reduce the time from their [screening] order to the completion of their order. If they needed a biopsy or if they were going to [receive] a cancer diagnosis, [we aimed] to [conduct those] as quickly and as efficiently as possible through individual navigation.
We also looked at barriers to screening in our system and tried to address them. We partnered with a mobile mammography unit, so we could do screenings right where the patients come for their primary care. We used secure text messaging to streamline communication. We made standard orders, so the navigators didn’t have to reach a doctor to update an order if a patient needed a second study that was already built into our system. [All these interventions] helped streamline every possible way that screening or follow-up could be delayed, [allowing these processes to get] done quickly.
What were the key findings from this analysis of services to improve breast cancer screening access?
We’re proud of our outcomes. We reduced the time from [screening] order to cancer diagnosis. It took over 6 months prior to our intervention, and we reduced it to 80 days.
We also found a decrease in late-stage diagnoses. This is a small sample size. We had approximately 30 breast cancers diagnosed the first year, which was our baseline year, and approximately 27 breast cancers the next year. These are small numbers, but nonetheless, the late-stage cancer diagnosis rate went from 23.3% to 7.4%. We found that effect exciting. It wasn’t a large enough sample size to reach statistical significance, so one of the things we want to do is continue to monitor that outcome to see if it’s a sustained benefit. We are also focusing next year on targeting patients who have genetic risk factors or family history risk factors that put them at a higher risk of developing breast cancer to make sure those patients, who might be younger than 40 years of age, receive the screenings they need as well.
What is your advice for colleagues looking to bring some of these patient navigation interventions to their own oncology practices?
There’s no substitute for one-to-one relationships with patients. Sometimes we want to look for efficiencies in this technology age. We want the internet and artificial intelligence to solve everything for us.
But for our population, they have low literacy levels. They might not have Wi-Fi. They might not have good cell phone service. They still need that human touch that our navigators provided. Even though, in some ways, [these services are] not as efficient as plug-and-play technology, if you look at [the outcomes, they] end up being so effective that they are a good-value investment in a health care model. We still need people helping patients get what they need.
References
- Welman M, Henry J, Hojvat-Gallin N. Breast cancer screening patient navigation decreases time to screening and diagnosis for FQHC patients. Presented at: 2025 San Antonio Breast Cancer Symposium. December 9-12, 2025; San Antonio, Texas. Abstract PS5-10-26.
- Welman M. Dr Welman on a study of the effects of patient navigation on breast cancer screening. Accessed February 20, 2026. https://www.onclive.com/video-series/dr-welman-on-a-study-of-the-effects-of-patient-navigation-on-breast-cancer-screening
