Harold P. Freeman Patient Navigation Institute: Providing Breast Health Navigation for Underserved Women
The Harold P. Freeman Patient Navigation Institute was founded in 1990 as the nation’s first Patient Navigation Program to reduce disparities in access to health care, specifically, among poor and uninsured New Yorkers. In 1967, Dr. Freeman began his work as a cancer surgeon at Harlem Hospital. During his time at Harlem Hospital, he noted the death rate from cancer among African Americans was the highest in the country and five year survival rate for African American women treated for breast cancer was significantly lower (39%), compared to the 75% five year breast cancer survival rate for Americans overall.
In a 2014 article written by Dr. Freeman and published in the New York Times, he is quoted as saying “I imagined I could cut cancer out of Harlem but I soon learned that the disease would not yield to the surgeon’s knife”. Dr. Freeman began to investigate the reasons for the disparities and found several barriers among many of the women he treated. Noted among the barriers were, limited knowledge related to breast cancer, poverty, lack of access to medical treatment, fear, and lack of resources in general. As more and more African American women were visiting the clinic for the first time, Dr. Freeman found that many of these women were presenting with late stage, invasive breast cancer with little hope for successful treatment and survival, due to late detection. At this time Dr. Freeman began seeking answers to the question: What does it mean to be poor and what does it mean to be African American and poor in America? Through his research and commitment to improving the medical outcomes for poor African American women diagnosed with breast cancer, he designed a framework for patient navigation through which women can be assisted and supported from outreach, screening, diagnosis, treatment and survivorship; while at the same time eliminating or reducing barriers that hinder the process.
In 1979, Dr. Freeman started a free breast screening clinic at Harlem Hospital that is patient-centered, and addresses financial, cultural, educational, and any other concerns identified by the patient or the navigator that could delay or prevent breast cancer screening and treatment. Since the implementation of patient navigation for breast cancer patients at Harlem Hospital, Dr. Freeman has documented and reported a significant decline in the number of African American women dying from late stage breast cancer and improvement in the five year survival rate from 39% to 70%.
In 2012, the American College of Surgeons, Commission on Cancer, mandated that, beginning on 2015, cancer programs will be required to have a patient navigation system in place in order to receive approval from the College.
In support of early detection and treatment, Philadelphia Corporation for Aging (PCA) has been and is currently a proud recipient of grant funds through the Komen Philadelphia Community Grants Program.
The grant allows PCA to provide breast health education and navigation to screening for older women age 60+. While the identified target group for the 2017-2018 grant is African American women, any woman seeking breast cancer education and screening will be served. PCA has the goal of reaching 250 women with up-to-date breast cancer education based on information approved by Susan G. Komen national standards. In addition, PCA plans to navigate 50, self-identified women to mammography and other breast health services as needed.
References: Freeman, HP, Muth, BJ, Kerner, JF. Expanding access to cancer screening and clinical follow up among medically underserved. Journal American College of Surgeons, 2003:196:180-188.