Abstract B65: Coordinated care model to reduce rural disparities in breast cancer mortality

Abstract

Abstract To identify underlying causes of excess breast cancer mortality in the Bootheel region of Missouri we conducted a needs assessment across 10 counties. An urban/rural disparity compounds the effects of racial disparity on breast cancer screening, incidence, and mortality rates in Missouri. The Bootheel region is the second most populous region ranked according to proportion of the population living below poverty level and has breast cancer mortality higher than other regions in the state. We used GIS data to map county level data on breast cancer rates, poverty distribution, and geographic location of relevant specialty physicians/services such as mammography, surgeons, and medical oncologists. Overlay of poverty distribution and Show Me Healthy Women provider maps reflects accessibility of statewide assistance for breast cancer screening/diagnostic services in relation to areas of need. Provider-by-type maps represent the physical distance women would need to travel in order to receive breast health screening and/or services. We conducted interviews with regional stakeholders including county health departments, hospitals, federallyqualified health centers & rural health clinics, private providers/offices, social service organizations, physicians, survivors, and age-eligible women. Needs assessment included on site interviews with over 50 individuals associated with breast cancer prevention and/or treatment in the region. Informants are diverse and representative of the region and their county. Barriers to access to breast health services included financial constraints, geographic and cultural limitations, lack of funding for the breast and cervical cancer-screening program. This region exceeds state averages for the proportion of women over 40 who have never had a mammogram. Breast health services along the continuum from early detection to access to treatment all need improvements. Research and service priorities include improved assistance for uninsured to access screening; improved understanding of physiologic social and environmental factors affecting breast health; implementation of sustainable programs to improve adherence to breast screening and risk factor reduction; improved patient navigation and communication between providers along the continuum of care; and increase awareness among community leaders of the magnitude of excess breast cancer burden in the Bootheel. The effectiveness of and strategies for effective navigation in a rural isolate population setting must be evaluated. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B65.