World Breast Cancer Day, marked on 25 October, focuses attention on awareness, early detection and access to care. Screening is an essential part of this effort, but what happens when a mammogram reveals a suspicious finding? Who makes sure that the woman receives the investigations and care she needs? When a woman receives an abnormal mammogram result, the next steps may involve further imaging, biopsy, pathology assessment, surgical consultation and oncological planning, often across different professionals, departments and facilities. Yet patients may still find themselves responsible for arranging appointments, navigating referrals and understanding how the different steps fit together. This challenge is particularly relevant in Greece, where breast cancer is the most commonly diagnosed cancer among women, with an estimated 8,733 new cases and 2,398 deaths in 2024.1 During the first cycle of the national PROLAMVANO screening programme, 87,231 women had mammographic findings requiring further evaluation.2 The benefits of screening depend on what happens next: timely diagnostic evaluation, access to appropriate treatment and coordination between services. Patient navigation and integrated breast cancer care offer different but complementary ways to organise this process, reducing the burden on women to manage it themselves.
Patient navigation: Addressing gaps in care coordination
The need for better coordination along the care pathway is not specific to breast cancer. During the final event of the HEALTH-IQ project, the panel “Mapping Patient Pathways and Identifying Unmet Needs in Lung Cancer, Pulmonary Hypertension and Dementia” highlighted the need for patient navigation across three conditions with very different clinical characteristics and care pathways. That the same need was identified across three very different conditions suggests that the problem goes beyond the management of individual diseases. It may also reflect how healthcare services are organised and how patients move between them. Although breast cancer was not examined in the project, the same question is relevant: when patients need to move between multiple specialists and services, who ensures that their care remains coordinated?
Patient navigation is one approach to addressing this challenge.
A patient navigator helps patients understand the next steps in their care, access the services they need and overcome practical barriers along the way.³ Depending on the setting, this role may be undertaken by nurses, social workers or other trained personnel. Patient navigators work alongside the clinical team, without replacing clinical decision-making.³
What does the evidence show?
Research suggests that patient navigation can improve certain aspects of breast cancer care, particularly the transition from an abnormal screening result to a confirmed diagnosis. A meta-analysis of randomised clinical trials found that navigation reduced the time to diagnostic resolution by approximately 10 days on average, although the benefit varied considerably between studies.⁴ In one randomised trial, women receiving navigation reached diagnosis in an average of 25.0 days, compared with 42.7 days with usual care.⁵ Not all trials found the same benefit. Navigation appears to make a greater difference for women at risk of prolonged diagnostic delays.⁶˒⁷ The evidence is less consistent for later stages of the pathway. Some studies have reported shorter intervals between diagnosis and treatment initiation, of 17 and 26 days, particularly among underserved populations, while others have found no statistically significant improvement.8 Benefits are not limited to waiting times, however. In a randomised trial of 251 patients with newly diagnosed breast, colorectal or lung cancer, nurse navigation did not significantly improve quality of life but was associated with fewer problems relating to care coordination, information and psychosocial support.9 The evidence also has limits. The pooled effect on completion of diagnostic work-up was imprecise 4, and economic evidence derives mainly from the United States and cannot be transferred directly to European health systems.3 Effectiveness depends on the needs of the population and on the organisation of the surrounding services.10
Beyond waiting times, patient navigation may also improve patients' experiences of care, particularly in relation to coordination, information and psychosocial support.
The Greek reality: Gaps along the breast cancer pathway
In Greece, women with breast cancer report delays in appointments, difficulties reaching specialised services and financial barriers to care. A survey by the Hellenic Association of Women with Breast Cancer, Alma Zois, with the University of West Attica, of 552 women diagnosed and treated between 2019 and June 2023, found that 29.7% had waited for a medical appointment, 23% had difficulties related to distance and 19% reported that an appropriate specialist was not available in their area.11 Furthermore, 23.2% believed that they had not received care in time, primarily because of delays in diagnosis and examinations, while 81.2% reported that they had acted promptly after noticing a suspicious finding.11 Delays therefore cannot automatically be attributed to patients postponing consultation, and they may also arise after initial contact with the healthcare system, as patients move between services. Private payments for diagnosis and treatment averaged €4,673, and 31% reported that expenses had greatly or very greatly worsened their financial situation.11 The findings are consistent with the EU Country Cancer Profile for Greece 2025, which notes that almost two-thirds of oncology hospitals and clinics are concentrated in Athens and Thessaloniki, together with pathology staffing shortages, delayed laboratory testing and long public-hospital waits for surgery and radiotherapy.12 A navigator cannot compensate for unavailable specialists or prolonged waiting lists. However, a defined coordination function may help patients access existing services more effectively, particularly when care is delivered across multiple facilities.
Why screening makes coordination even more important
Inviting women to participate in screening is only one part of the process. Services also need to ensure that abnormal findings are followed up and that women receive the necessary diagnostic investigations. International evidence associates delayed or incomplete follow-up after abnormal mammography with ineffective communication, fragmented records, inconvenient clinic hours and inadequate systems for retrieving results.13 In Greece, the publicly reported figures demonstrate the reach of the PROLAMVANO programme, but they do not establish how many women requiring further investigation completed the diagnostic process or how long it took, and the country profile notes the absence of a published evaluation of the programme’s impact on stage at diagnosis.12 Monitoring what happens after an abnormal result is therefore essential.
From patient navigation to integrated breast cancer care
Patient navigators can help women move between services, but many of the difficulties they address arise from how care is organised. Specialist breast centres seek to reduce these gaps by bringing diagnostic services, treatment planning and patient support into a coordinated multidisciplinary structure. Treatment in certified breast cancer centres was associated with lower all-cause mortality than treatment in non-certified facilities in an observational study, with hazard ratios of 0.77 and 0.88 in two data sources,14 and breast cancer mortality was 18% lower than in comparison areas after the introduction of multidisciplinary team working within a regional service.15 Not all analyses agree, since an earlier registry analysis found no survival difference among patients aged up to 75 years.16 These observational studies do not show that coordination alone explains the differences, but they support organised, multidisciplinary models of care. European standards provide a practical framework. The EUSOMA recommendations describe dedicated multidisciplinary teams, coordinated access to diagnostic and treatment services, shared clinical information and specialised breast care nursing, and they do not set a specific requirement for patient navigators.17 Patient navigation and integrated breast centres should therefore be viewed as complementary rather than competing approaches. A navigator can bridge gaps where care remains fragmented, and within an integrated centre the same functions can become part of an established structure, which is consistent with the finding that navigation is more sustainable when embedded in routine services than when it depends on external funding.18 The wider policy direction is similar, since Europe’s Beating Cancer Plan aims for 90% of eligible patients to have access to National Comprehensive Cancer Centres linked through an EU network by 2030.19
What needs to change? Implications for healthcare organisation in Greece
Introducing patient navigation in Greece would require more than creating a new professional title. A practical starting point could be targeted programmes within existing breast services, focusing on the period between an abnormal screening result and the initiation of treatment, with priority for women living far from specialised services or facing financial barriers. Several requirements should be considered.
- Clear responsibilities and referral pathways. Navigators should have defined responsibilities and established communication with the multidisciplinary team, and evaluation should include patient experience and equity.
- Systematic monitoring of pathways. Services should track diagnostic completion, waiting times and treatment initiation, since improvement in one outcome does not imply improvement in the others.4,8
- Integration with existing services. Navigation should be embedded in clinical workflows rather than operate as a temporary activity, with attention to role clarity, workforce capacity and sustainable funding.10,18
Patient navigation could help address immediate gaps in breast cancer care in Greece. Its introduction, however, should form part of a wider effort to develop integrated breast services, with clear referral pathways and shared responsibility for coordinating care. Women should not have to manage the transitions between screening, diagnosis and treatment on their own. Ensuring that these steps are connected is a responsibility of the healthcare system.
References
1.International Agency for Research on Cancer. GLOBOCAN, Greece fact sheet (estimates for 2024). gco.iarc.who.int
2.Ministry of Health (Greece). PROLAMVANO programme, first-cycle results, statement of 13 October 2026, as reported by OENET. oenet.gr
3.Chan R, et al. Patient navigation across the cancer care continuum: an overview of systematic reviews and emerging literature. CA Cancer J Clin. 2023. doi:10.3322/caac.21788
4.Tian L, et al. Impact of patient navigation on population-based breast screening: a systematic review and meta-analysis of randomized clinical trials. J Gen Intern Med. 2022. doi:10.1007/s11606-022-07641-y
5.Ferrante J, et al. The effect of patient navigation on time to diagnosis, anxiety, and satisfaction in urban minority women with abnormal mammograms: a randomized controlled trial. J Urban Health. 2007. doi:10.1007/s11524-007-9228-9
6.Bastani R, et al. Low-income women with abnormal breast findings: results of a randomized trial to increase rates of diagnostic resolution. Cancer Epidemiol Biomarkers Prev. 2010. doi:10.1158/1055-9965.EPI-09-0481
7.Battaglia TA, et al. The impact of patient navigation on the delivery of diagnostic breast cancer care in the National Patient Navigation Research Program: a prospective meta-analysis. Breast Cancer Res Treat. 2016. doi:10.1007/s10549-016-3887-8
8.Baik SH, et al. Patient navigation in breast cancer treatment and survivorship: a systematic review. J Clin Oncol. 2016. doi:10.1200/JCO.2016.67.5454
9.Wagner E, et al. Nurse navigators in early cancer care: a randomized, controlled trial. J Clin Oncol. 2014. doi:10.1200/JCO.2013.51.7359
10.Muzio K, et al. The value of the nurse navigator in complex cancer care: a scoping review. Healthcare. 2025. doi:10.3390/healthcare13131585
11.Alma Zois. «Το ταξίδι των ασθενών με καρκίνο του μαστού στην Ελλάδα: 10 χρόνια μετά»: Τα πρώτα αποτελέσματα. 2024. almazois.gr
12.OECD, European Commission. EU Country Cancer Profile: Greece 2025. oecd.org
13.Reece J, et al. Delayed or failure to follow-up abnormal breast cancer screening mammograms in primary care: a systematic review. BMC Cancer. 2021. doi:10.1186/s12885-021-08100-3
14.Schoffer O, et al. Treatment in certified breast cancer centers improves chances of survival of patients with breast cancer. Geburtshilfe Frauenheilkd. 2023. doi:10.1055/a-1869-1772
15.Kesson E, et al. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ. 2012. doi:10.1136/bmj.e2718
16.Schrodi S, et al. No survival benefit for patients with treatment in certified breast centers: a population-based evaluation of German cancer registry data. Breast J. 2015. doi:10.1111/tbj.12444
17.Biganzoli L, et al. The requirements of a specialist breast centre. Breast. 2020;51:65-84. doi:10.1016/j.breast.2020.02.003
18.Saharudin SN, et al. Planning and sustaining breast cancer patient navigation programs: a CFIR-informed scoping review of implementation determinants. Int J Health Plann Manage. 2026. doi:10.1002/hpm.70129
19.European Commission. Europe’s Beating Cancer Plan: a new EU approach to prevention, treatment and care. Press release IP/21/342. 2021. ec.europa.eu
