At the Avon Forum, we presented data from the Access to Care programs (BHOP, Centers of Excellence, and Safety Net). In particular, we looked at trends in screening outcomes, patient navigation, and client demographics from the quarterly/mid-year data reports and Client Intake Forms (CIFs) submitted by BHOP grantees.
The percent of newly diagnosed breast cancer cases increased steadily between 2010 and 2015 among Safety Net grantees. The rate increased by 1.8%, going from 1.4% in 2010 to a high of 3.2% in 2015. Among BHOP grantees, the percent of newly diagnosed breast cancer cases has been relatively steady since 2010, at approximately 0.7%.
Since we started collecting diagnostic data in 2015 among BHOP grantees, the majority of breast cancer cases, 77% in 2015 and 80% in 2016, were diagnosed at Stage II or earlier. And approximately 20% of breast cancer cases were diagnosed at later Stages III and IV in both 2015 and 2016. Among Safety Net grantees, we have been collecting diagnostic data since 2010. The greatest percentage of breast cancers were reported as Invasive Ductal Carcinoma in Situ, at an average of 54% from 2010-2015. The next greatest percentage of breast cancers were reported as Ductal Carcinoma in Situ (or DCIS) at an average of 20% from 2010-2015. Starting in 2016, both BHOP and Safety Net grantees report based on Stages 0-IV so all Access to Care programs are reporting on the same metrics.
Patient navigation services are defined as services that go above and beyond scheduling an appointment for a client. We have been collecting patient navigation data from Safety Net grantees since 2010. The most reported patient navigation service over the years has been Financial Assistance Referrals. The biggest gain was among Support Group/Counseling Referrals which have increased by 95 referrals from 2010 to 2015. The biggest decline was among Transportation Assistance which decreased by 37 services provided from 2010 to 2015. In 2015, BHOP grantees started reporting patient navigation services. The most reported are Financial Assistance Referrals and Language Interpretation services. With Language Interpretation services, more clients from minority and immigrant backgrounds are able to access breast cancer screening services.
All BHOP grantees submit a Client Intake Form (CIF) for each client who receives a mammogram as a result of their outreach and education activities. Data trends from 2010-2016 include:
- The percent of clients by race has remained relatively consistent over the years. The greatest change is the percent of whites screened, which has declined slightly from a high of nearly 50% to 40%. The percent of blacks/African American clients has increased slightly from 15% to nearly 20%. Lastly, the percent of Hispanic clients has increased over the years from 25% to a high of 37% in 2015.
- The income level of clients has remained fairly steady over the years. The percent of clients with incomes under $25,000 has been 70% on average, and those with incomes $25,000 or greater has been 20%, on average. [Note: 10% did not respond, as some find this a sensitive question or don’t know]
- Clients’ insurance statuses have been changing in recent years. The percent of uninsured clients has been at a steady decline since 2014, the same time that the Affordable Care Act and the expansion of Medicaid came into effect. The highest level of uninsured clients was 64%, and in 2016 the level has decreased to 54%.
- The percent of clients reporting having had a clinical breast exam (CBE) or mammogram in the past 2 years dipped slightly from 2010 to 2011, but has seen a steady increase since then to 73% and 65% respectively, in 2016.
- Having a relative with breast cancer has been a prominent risk indicator, having had the most dramatic change in recent years. This indicator has increased from a low of 16% in 2011 to a high of 49% in 2015. As it currently stands, 2016 looks to display numbers similar to 2015, with 47% of clients reporting having a relative with breast cancer to date this year.