The impact of race and language concordance between patients and navigators on time to diagnostic resolution of breast and cervical cancer screening abnormalities
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BACKGROUND: Patient navigators have been shown to reduce cancer disparities among racial/ethnic minorities by improving timely diagnosis and treatment of cancer. We sought to determine if race/ethnicity and language concordance of patients and their navigator improved time to diagnostic resolution of breast and cervical cancer screening abnormalities. METHODS: Demographic data on patients and navigators from the Boston Patient Navigation Research Program were used to assess concordance by race, ethnicity, and language. Kaplan-Meier survival curves and Cox proportional hazards regression models examined the association of race/ethnicity and language concordance on time to definitive diagnosis of cancer screening abnormalities. All analyses were performed separately for breast and cervical groups. RESULTS: There were 1257 patients and 23 navigators in this study. In the breast group (n=655), 44% of patient-navigator pairs were concordant by race/ethnicity and 75% were language concordant. In the cervical group (n=602), 70% of patient-navigator pairs were race/ethnicity concordant and 87% were language concordant. There was no association with race/ethnicity concordance and time to diagnostic resolution for the breast group, aHR 1.19 (95% CI: 0.97, 1.46) or cervical group, aHR 1.23 (95% CI: 0.99, 1.53). However, in the stratified analysis, race/ethnicity concordance was associated with timelier resolution for minority women with breast and cervical cancer screening abnormalities but not for Whites. For cervical cancer screening abnormalities resolving in less than 90 days, language concordance was also associated with timelier resolution, aHR of 1.46 (95% CI: 1.18, 1.80) but there was no association in the breast group. In the subgroup analysis of Spanish concordance there was also an association of timelier resolution for those with cervical cancer screening abnormalities resolving in less than 90 days. CONCLUSION: Patient-navigator race/ethnicity concordance is associated with timelier diagnostic resolution of breast and cervical cancer screening abnormalities among minority women. Language concordance is also associated with timelier resolution in participants with cervical cancer screening abnormalities despite the availability and use of interpreters. Given poorer cancer outcomes among minority women, the use of patient navigators that are diverse by race/ethnicity and multilingual may help address barriers to care and improve health outcomes among low-income minorities.