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Retrospective Study: Reducing Delays in Breast Cancer Diagnosis



In response to concern about delay in breast cancer screening and diagnostic services within the St. Louis safety-net system, the St. Louis affiliate of Susan G. Komen for the Cure invited PECaD to submit a grant application for funding to assess perceived and/or real delays in breast cancer screening and diagnostic referral processes. PECaD received grant funding from the St. Louis affiliate for a project titled “Reducing Delays in Breast Cancer Diagnosis in the St. Louis Public Safety-Net System,” which focused solely on women referred from safety-net providers to the Siteman Cancer Center.


The purpose of the project was to identify, through a medical record review, system factors related to delay in breast cancer referral among women from the safety-net system and to implement changes to reduce the delay. In order to identify factors contributing to the delays, PECaD conducted detailed chart audits of 73 St. Louis ConnectCare patients with breast abnormalities and women diagnosed with breast cancer to assess the breast referral process, quantify delays and identify systematic or logistical factors that might prolong breast cancer diagnosis. Five points of interest were captured:

  • Date of first sign of/presentation of a breast abnormality
  • Date clinical follow-up was complete
  • Date of primary-care physician referral to a St. Louis ConnectCare Surgery Center clinic
  • Date of a ConnectCare clinic appointment
  • Date of definitive treatment (defined as surgery or record of benign finding)

Results were shared with the St. Louis Regional Health Commission (RHC) and St. Louis Integrated Health Network (IHN), which led to development of an IHN Breast Cancer Referral Initiative Workgroup that was charged with mapping current referral processes, sharing best practices and making system recommendations to decrease time from a first system contact to a diagnosis. The IHN workgroup included collaborators from the safety-net system, the Joanne Knight Breast Health Center at Siteman, PECaD and patients in the system.


The IHN workgroup developed a recommended flow chart to expedite referral of women in the safety-net system to specialty breast care. The workgroup has disseminated the flow chart, and it is currently being used by safety-net providers.

Next Steps

The safety net and its partners continue to move forward to develop a long-term plan for continuous quality improvement to expedite referral of women to breast cancer care, including enhancement of patient navigation efforts. A parallel initiative supported by PECaD is a regional breast cancer navigation workgroup that meets quarterly to share resources, best practices and suggestions for system improvements. This group is facilitated by a safety-net provider.


St. Louis affiliate of Susan G. Komen for the Cure

Project Staff

Julie Margenthaler, MD (Primary Investigator, Washington University)
Graham Colditz, MD, DrPH (Co-Primary Investigator, Washington University)
Dione Farria, MD, MPH (Co-Investigator, Washington University)
Donna Jeffe, PhD (Co-Investigator, Washington University)
Jennifer Tappenden, RHIA (Data Manager, Washington University)
Courtney Beers, MPH (Coordinator, Washington University)
Susan Kraenzle, RN (Collaborator, Siteman Cancer Center)
Barbara Monsees, MD (Collaborator, Washington University)
Katherine Mathews, MD, MPH, MBA (Collaborator, Southern Illinois Health Care Foundation, formerly with St. Louis ConnectCare)

Contact Information

Julie Margenthaler, MD
Phone: 314-362-7534