System-level barriers to breast cancer screening completion in community-based navigation: lessons from a quality improvement initiative.

Authors

Lisa Carter-Bawa, Miriam Lucca-Susana, Ebony Orr, Subha Jamal, Elan N Shoulders

Published in

BMJ open quality. Volume 15. Issue 3. Aug 12, 2026. Epub Aug 12, 2026.

Abstract

Black and Latina women experience persistent breast cancer screening disparities. Patient navigation has demonstrated effectiveness in clinic-based populations, but evidence regarding navigation for women engaged through community outreach remains limited.
In Northern New Jersey, late-stage breast cancer diagnosis rates among black women range from 38% to 44% compared with 27% among all women. Our institution lacked a systematic community-based outreach-to-screening navigation pathway.
This quality improvement initiative, conducted from December 2023 through December 2025 within a large integrated health system, leveraged existing Community Outreach and Engagement infrastructure across 230 community events, tracking a navigation process cascade from engagement through screening completion. Eligibility: women aged 40+ years without a mammogram in the past 12 months (United States Preventive Services Task Force/American Cancer Society).
The programme included community outreach, eligibility screening, navigation enrolment, navigator follow-up (4-6 contact attempts over 4-6 weeks), scheduling support and social needs screening.
The programme engaged 1318 women; among 277 with demographic data, 80.9% identified as black or Latina and 78.8% were uninsured. Of 564 screened for eligibility, 333 (59.0%) enrolled in navigation. Contact success was 73% (210/288 with documented contact attempts in 2024). A critical gap emerged at scheduling: only 5 women (1.5% of enrolled) had mammography scheduled. Post-hoc analysis revealed navigators lacked operational authority to schedule appointments directly. Among 400 women completing social needs screening, 96.0% reported food insecurity.
This initiative identified an immediately actionable infrastructure gap: navigators lacked direct scheduling authority, appearing to be a critical barrier to translating engagement into completed care. The 96% food insecurity prevalence characterises a population facing compounding structural barriers, suggesting self-scheduling may be a structurally inequitable expectation. We propose that direct scheduling authority is a potentially necessary condition for effective community-based navigation-a hypothesis warranting prospective testing.

PMID:
42586585
Bibliographic data and abstract were imported from PubMed on 13 Aug 2026.

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