Aim Patient culture creates a transparent yet substantial barrier to medical care. 1. Inadequate communication, poor public literacy, language differences alter the response to health messages. 2.Delays in accepting treatment suggestions, differing beliefs of disease/healing results from the conflict between traditional medicine; cultural beliefs; conventional medicine. 3. Rejection of the biomedical model due to failure in communication and understanding. Methods The Helen Joseph breast care clinic manages 500-700 patients monthly with approximately 350 new diagnoses each year. Locally advanced disease (62%) accounts for the majority of breast cancer diagnoses. Navigators are breast cancer survivors from diverse cultural backgrounds, ages and ethnicities who function as clinical coordinators/counsellors ensuring compliance. This system provides awareness of unseen barriers around patient care from failed clinician communication. Results: Navigating the divide of breast health care Phenomena that affect help-seeking behaviour are ignorance of what the symptom means; fear of management strategies; outcomes of the disease/treatment process. Conceptualizing three navigational barriers, creating a patient care model to ensure better outcomes. 1. Navigating the Neighborhood. Patient navigators from the community highlighted reasons for failure and redirecting information based on cultural belief systems resulted in an increase in patient attendance. Problems such as the diversity of languages spoken, poor literacy and suspicion of accepting advice from women of different cultural backgrounds were corrected by the involvement of the navigator, providing personalized information and training: understanding preconceptions/beliefs around the cause of cancer, which were resulting in women not accessing care. 2. Navigating Hospital Environments: Insight into the perception of a “hostile hospital environment”: Accessing chemotherapy facilities; hospital admissions for breast cancer surgery; transport; monetary issues - prevent patients attending clinics; receiving medication and collection of medication repeats in financially burdened patients affect compliance. Daily trips to clinics may result in choices of mastectomy over breast conservation. 3. Navigating medical consultations Misinformation around treatments or complications around clinical modalities of care may not be addressed by the treating physician. Some cultures do not have a model of patient autonomy, with disease perceived as a family issue it is important to ascertain to whom the news of diagnosis should be directed. Each patient is contacted monthly to determine concerns (logistically and medically) to facilitate compliance with treatment. Concerns around the concept of a mastectomy is not a phenomenon unique to non-westernized cultures and are often managed insensitively by medical practitioners with the attitude of ‘life over limb’. Women may be unaware of advances such as breast-conserving surgery and delay treatment due to fear of mastectomy. Conclusion The interplay between medicine, culture and beliefs in breast cancer underlines the importance of patient navigators in the MDT. Navigators should have diverse medical and cultural areas of expertise ensuring communication between physicians, patients/families and communities

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