Improving breast cancer screening for indigent minorities: A county hospital cancer center's experience

Abstract

17020 Background: Indigent, minority women with breast cancer present with later stage disease, often because of lack of access to affordable screening tests. Breast exam and mammography are effective at early detection. A screening program targeting minority women is important, especially in an area with a high poverty rate. The most effective way to reach this population, though, has not been well established. Methods: From 11/03–7/05, 4 breast cancer screenings were performed at our cancer center which targeted poor, minority populations in the Cleveland area. Despite culturally appropriate advertisements and free exams by physicians, only 42 women were screened. To improve upon this, a bilingual community breast liaison was hired. An advisory council of community representatives was established which led to collaborations with over 100 neighborhood agencies. The venue for the screenings was changed to easily accessible locations (churches, shelters) and transportation was provided. Free clinical breast exams (CBE) were performed by experienced physicians and on-site mammograms (mam) were done. From 10/05–10/06, 7 community breast screenings were held. 403 women were screened and over 2000 were educated. Results: 98% were impoverished; 94% had an annual income of <$25,000. 78% had no health insurance. Median age=46 (range 35–89). 31% Latino; 46% AA; 16% Caucasian. Many pts had not had a mam (91%) or CBE (84%) within the past year; many never had either screening test before (31% never had a mam and 17% never had a CBE). The most common reason for this was lack of insurance (60%). “Too young” was the second most common reason (7%). Most common reason for coming to screenings: free services (49%). Of 403 pts screened, 27/371 had abnormalities on CBE and 26/293 mam were abnormal. Thus far, 2 cases of breast cancer have been diagnosed (stages I and II). Conclusion: Indigent minority women do not receive adequate breast cancer screening due to many barriers, including cost. To reduce this disparity, our center targeted this population. After adjusting our approach, screening attendance markedly improved, increasing from 42 to 403 pts screened. This improvement was due to cancer center services being brought out to the community and an active engagement of community organizations. No significant financial relationships to disclose.