Breast Health Knowledge Research Articles

Breast Health Perceptions and Screening Behaviors Among Myanmar American Immigrant Women.

To understand and describe attitudes toward general health checkups, breast health knowledge, cultural beliefs, and health-promoting behaviors among Myanmar American immigrant women in the United States. 267 women participated in the study. 10 women were excluded because of missing data, so the total sample size was 257 participants. A descriptive, cross-sectional survey design was used to describe and investigate breast health perceptions and behaviors. Nearly 75% of the study sample reported having negative attitudes toward general health checkups and were found to have less accurate breast health knowledge and more fatalistic views about breast cancer. Only 29% of older women adhered to mammogram recommendations. Younger women reported more barriers to mammograms, and older women reported fewer barriers to mammograms. This study demonstrated the need for additional research focusing on unique perspectives when investigating breast health practices among Myanmar American immigrant women. The findings highlight the essential need to build a strong partnership with stakeholders to combat breast health disparities and address the complex nature of acculturation.

Patients' experiences undergoing breast evaluation in Rwanda's Women's Cancer Early Detection Program.

There is urgent need for interventions to facilitate earlier diagnosis of breast cancer in low- and middle-income countries where mammography screening is not widely available. Understanding patients' experiences with early detection efforts, whether they are ultimately diagnosed with cancer or benign disease, is critical to optimize interventions and maximize community engagement. We sought to understand the experiences of patients undergoing breast evaluation in Rwanda's Women's Cancer Early Detection Program (WCEDP). We conducted in-person semi-structured interviews with 30 patients in two districts of Rwanda participating in the WCEDP. Patients represented a range of ages and both benign and malignant diagnoses. Interviews were recorded, transcribed, translated, and thematically analyzed. Participants identified facilitators and barriers of timely care along the breast evaluation pathway. Community awareness initiatives were facilitators to care-seeking, while persistent myths and stigma about cancer were barriers. Participants valued clear clinician-patient communication and emotional support from clinicians and peers. Poverty was a major barrier for participants who described difficulty paying for transport, insurance premiums, and other direct and indirect costs of hospital referrals in particular. COVID-19 lockdowns caused delays for referred patients. Although false-positive clinical breast exams conferred financial and emotional burdens, participants nonetheless voiced appreciation for their experience and felt empowered to monitor their own breast health and share knowledge with others. Rwandan women experienced both benefits and burdens as they underwent breast evaluation. Enthusiasm for participation was not reduced by the experience of a false-positive result. Reducing financial, logistical and emotional burdens of the breast diagnostic pathway through patient navigation, peer support and decentralization of diagnostic services could improve patients' experience.

Evaluating a Comprehensive and Cost-Effective Accelerated Breast Health Curriculum in Guyana for Healthcare Providers

The incidence and mortality rate of breast cancer continues to rise in Guyana. One key factor contributing to this issue is that Guyana does not have a national breast cancer screening program nor the resources or infrastructure to support one. As a result, it is important to consider cost-effective solutions that can promote the early detection of breast cancer. The literature suggests a promising intervention could address gaps in frontline healthcare providers' knowledge and understanding of breast health. Providers who receive dedicated curricular training in breast health in conjunction with learning the clinical breast exam (CBE) and ultrasound tend to show an increase in their early detection rates. With this in mind, we sought to evaluate an existing breast health curriculum in Georgetown, Guyana, by measuring provider fund of knowledge before and after the intervention. Over 1 week, sixty-two participants, mostly nursing students, were divided into two groups. Each group participated in the two-and-a-half-day course. Participants were given a pretest assessment and then went through an intensive 8-module course complete with CBE training and ultrasound demonstration before taking a posttest. We found that while only one of the sixty-two participants passed the initial pretest assessment, forty of the sixty-two participants passed the posttest. Statistical analysis showed that the difference in test scores between the pretest and the posttest was statistically significant. While more studies are needed, these findings suggest that focusing on the breast health knowledge of providers in Guyana and other similar countries may be a highly effective yet cost-friendly intervention that could significantly improve early detection rates and ease the breast cancer disease burden.

Abstract P1-08-09: DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women

Abstract Breast cancer is now the most common cancer. Thirty years of increased awareness, early diagnosis, and treatment access contributed to a 40% decline in breast cancer deaths. Yet, in 2021, more than 281,550 new cases of invasive and 49,290 new cases of non-invasive breast cancer will be diagnosed in U.S. women. Black women are 40% more likely to die of breast cancer - the highest breast cancer death rate across racial and ethnic groups. Today, the Black-white breast cancer mortality gap persists, and Black metastatic breast cancer (MBC) patients have a poorer prognosis. The pandemic exacerbated breast cancer disparities. In 2020, delays and avoidance contributed to an 85% breast cancer screening drop while MBC patients’ risk of severe illness and death from COVID-19 elevated. Therapy interruptions and abandonment increased, and conversely, clinical trial enrollment decreased. COVID-19 has accelerated the digital platform shift to telemedicine, online psychosocial support programs, virtual patient navigation, and digital engagement across the oncology care continuum. DC Pink Divas Intervening Virtually to Advance Saving Lives (DIVAS) is an award-winning evidence-based training, outreach, and patient navigation program developed to address the educational needs of Black early-stage, MBC breast cancer patients, survivors, and caretakers and provide strategies to educate, empower and impact women by increasing breast health knowledge, decreasing gaps in screenings and access, increasing awareness of MBC to ensure that where a woman lives, will not determine if she lives through a 1-year commitment of attendance in 8 cohort-based education modules where Black breast cancer mortality is highest. The DIVAS Health Behavioral Change Model adapts the Precaution Adoption Process Model, Health Behavior Model, and Social-Ecological Model. DIVAS implements innovative virtual outreach programs, training, and intervention strategies to empower Advocates to educate peers, providers, and policymakers. 3 Cohorts of Black women impacted by breast cancer trained as Lay Breast Health Advocates from 2011, 2020, and 2021 (N = 57; 77.5 % 45 years or younger; 36.7% early-stage 0-II, 50% late stage III-IV, 10.3% caretakers) self-reported their lifestyle behaviors, breast cancer diagnosis, breast health education, social media use, and interest in a digital-based lifestyle intervention. Participants completed pre-and post-surveys, interviews, and journaling over 10.5+ hours of education modules to understand their breast health, provider-related challenges, and community-related resources. Findings provide evidence that cohort-tailored education is a successful method of supporting Black women in a behavioral-health intervention. The provision of printed culturally attuned information along with the digital-based instruction from a Black woman health care provider or public health expert is effective in helping Black breast cancer survivors transition into patient empowerment, improve QOL and contribute to better patient outcomes. After the intervention and completion of breast health modules, participants reported increased: self-efficacy in communicating with providers (70%) and self-efficacy in making treatment decisions (70%) self-confidence (85%), and a decrease in lifestyle risk factors (87%). Patient-centric behavioral health interventions in breast cancer education must be advanced digitally to address the pandemic’s compounded crisis. DC Pink Divas provides insights to combat rising disparities by educating, empowering, and mobilizing Black lay breast health advocates to improve outcomes. Collaborative digital interventions across the care continuum to improve awareness, access, adherence, infrastructure, culturally attuned training, and support are evidence-based methods for navigating the cancer care transformation accelerated by COVID-19 to advance breast health equity. DIVAS Logic Model 2011- 2022 Logic model demonstrating inputs, activities, outputs and short and long term outcomes 2020- 2021 Cohort Sentiments and Behaviors Cohort outcomes from DC Pink Divas DIVAS In-Person vs Virtual Training Lay Breast Health Advocates recorded outcomes from cohorts 2011, 2020, and 2021 Citation Format: Falasha Zuend, Shyrea Thompson, Lori Wilson. DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-08-09.

Integrating Breast Cancer Early Detection Into a Resource-Constrained Primary Health Care System: Health Care Workers' Experiences in Rwanda.

There is limited evidence to guide incorporation of breast cancer early detection into resource-constrained health systems where mammography screening is not yet available. To inform such strategies, we sought to understand health care workers' perspectives on a breast cancer early detection initiative integrated into community, primary, and secondary levels of care in Rwanda. We conducted a qualitative study using semistructured interviews with 33 community health workers, clinicians, and administrators at health facilities participating in the Women's Cancer Early Detection Program (WCEDP), through which women received clinical breast examination if they were receiving cervical cancer screening, or had breast concerns. Through thematic analysis, we identified dynamics and patterns associated with successes and challenges of the program's breast health services. Successes and challenges identified by participants corresponded with the community- and primary care-based steps of cancer early diagnosis identified by the WHO. Regarding step 1 (community awareness/access), participants noted increases in awareness and care-seeking. Challenges included difficulty overcoming stigma and engaging older women. Regarding step 2 (clinical evaluation), all participants described increased breast health knowledge, skills, and confidence. Integrating the WCEDP with other services was challenging because of inadequate staffing; offering WCEDP services on a designated day/week had advantages and disadvantages. Although participants appreciated WCEDP referral mechanisms, they desired more communication from referral facilities. Patients' poverty was the most consistently identified impediment to referral completion. Rwandan health care workers identified real-world successes and challenges of implementing principles of early cancer diagnosis for breast cancer early detection. Future interventions should focus on engagement of older women, community awareness, patient socioeconomic support, and optimizing integration into primary care.

Abstract OT2-10-01: The VIOLA study: Validating individualized breast cancer screening by offering a new link in access

Abstract The VIOLA Study is a Clinical Utility Study designed to investigate the useability of Melody®, a tear-based screening assay for breast cancer developed and validated by Namida Lab, Inc., a high complexity CLIA certified lab. It is well established that disparities exist in breast health, preventative care, and screening mammography. Namida Lab believes in the potential of Melody® to be a tool that bridges the gap between underserved populations and positive health outcomes. As such, Namida Lab, Inc. is partnering with federally qualified health centers and large employers to evaluate the clinical utility of Melody®. Melody® consists of two parts: tear sample collection and clinical lab assay. Participants will have a tear sample collected at a study site. The clinical lab assay, Melody®, will be performed at Namida Lab, Inc. The results of the Melody® assay will be returned to the site clinician to be discussed with the participant. The administration of Melody® does not require additional appointments or trips and can be done by any member of a medical team. A minimum participation of 205 women who are 40 to 74 years of age, at average risk for developing breast cancer, asymptomatic, and have no concerns or breast abnormalities. To date 28 participants have been enrolled in the study. Study enrollment and eConsent will be conducted through our mobile application. Each participant will be required to take an enrollment survey that collects information on race, ethnicity, and socio-economic status. Participant's addresses will be obtained as part of the requisition process for the CLIA lab, from which information on geographic location can be obtained. In addition to the factors listed above, the enrollment survey also collects information on status and type of health insurance, reproductive health, breast health knowledge, prior screening history, and family and personal history of cancer The exit survey has been designed to collect information on the participant experience with Melody® and comprehension of the Melody® results relayed through their site clinician. In addition, information is collected on participant''s intention to schedule/participate in future screening mammograms and/or change in intention to participate in a previously scheduled screening mammogram. Primary endpoint: The VIOLA Study is designed to assess how incorporating Melody® into a primary care provider setting affects participation and confidence in the current breast health continuum of care. Secondary endpoint: Quantifying the relationship between Melody® and increased participation in breast health care offers the clinical utility evidence required for adoption into the Standard of Care. Citation Format: Anna Daily. The VIOLA study: Validating individualized breast cancer screening by offering a new link in access [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-10-01.

Breast Cancer Early Detection in Eswatini: Evaluation of a Training Curriculum and Patient Receipt of Recommended Follow-Up Care.

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Breast cancer screening knowledge among Hungarian women: a cross-sectional study

BackgroundBreast cancer (BC) is the leading malignant tumor among women worldwide. Although attending regular BC screening effectively reduces cancer-related mortality, surveys testify that screening knowledge is critically low among women. We aimed to conduct a comparative cross-sectional survey to assess BC and BC screening-related knowledge in Hungary.MethodsWomen between 25 and 65 years of age without a previous history of malignant tumors were included with non-probability sampling in 2017. Respondents were recruited either from primary care (laywomen) or from the waiting rooms of mammography (screening attendees). A self-completion questionnaire was constructed with questions about BC (risk factors, signs and symptoms, curability, and mortality), BC screening (mammography and breast self-examination), and BC-related information sources to assess knowledge among laywomen and screening attendees. In addition to descriptive statistics, odds ratios with 95% confidence intervals were calculated in univariate analysis and logistic regression was used in multivariate analysis.ResultsAltogether, 480 women completed the questionnaire, of which 429 (227 laywomen and 202 screening attendees) were eligible for inclusion. Laywomen and screening attendees knew the recommended age at first mammography in 35.2% and 86.6%, the recommended frequency of screening in 33.9% and 12.9%, the recommended age at first breast-self examination in 38.8% and 51.2%, had sufficient knowledge of the risk factors of BC in 7.0% and 5.9%, and that of signs and symptoms of BC in 16.7% and 28.9%, respectively. A higher proportion of screening attendees correctly identified the recommended age of first BC screening correctly than that of laywomen (86.6% vs. 35.2%; p < 0.001). The most popular information sources were television among laywomen and general practitioners or specialists among screening attendees. In multivariate analysis, older age, higher education, and place of residency were significant predictors of the right answers.ConclusionsAlthough knowledge was insufficient in almost all fields of the questionnaire, the most prominent gap was observed concerning risk factors and signs and symptoms of BC both in laywomen and, unexpectedly, screening attendees. Most laywomen were lacking knowledge of screening protocol. These results urge breast health and BC knowledge interventions in Hungary.

Evaluating a Community-Based Breast Cancer Prevention Program for Rural Underserved Latina and Black Women.

Persistent racial and ethnic disparities and rural-urban disparities in breast cancer mortality in North Carolina require attention. The Pitt County Breast Wellness Initiative-Education (PCBWI-E) provided culturally tailored breast cancer education and navigation to age-appropriate screening services (mammography and clinical breast exams) for uninsured and underinsured Black and Latina women age 25 and older in two rural counties in North Carolina (Pitt and Edgecombe Counties). Using a lay health model, the PCBWI-E trained 23 community members and public health undergraduate students as lay breast health educators. Breast health educators educated 735 women across the 2-year program. Baseline knowledge about breast health was low at year 1 and 2 (mean knowledge score = 59%, SD = 0.21 and 57%, SD = 0.22, respectively) and was higher at follow-up post-intervention for both years 1 and 2 (mean knowledge score = 78%, SD = 0.18 and 75%, SD = 0.19, respectively) (p < 0.001). In terms of navigation, almost three-quarters (72%) of those recommended to receive a mammogram, received one. Of the population served by the PCBWI-E who were aged 40 and above, 34% had never received a mammogram. Of those women who had never received a mammogram, 68% received one through the PCBWI-E program. The PCBWI-E was successful in increasing both breast health knowledge and access to age-appropriate breast cancer screening among uninsured and underserved Latina and Black women in rural eastern North Carolina. Future efforts should support the large-scale implementation of successful evidence-based culturally appropriate models like this one in the reduction of racial, ethnic, and rural breast cancer disparities.

Abstract B104: [Advocate Abstract] Evaluating the impact of strategic partnerships

Abstract Despite progress in reducing racial disparities in breast cancer mortality, black women in Chicago are still more than twice as likely to die from the disease than white women. For sixteen years, Sisters Working It Out (SWIO), a 501c3 nonprofit, has utilized peer education and patient navigation as evidence-based methods to increase breast cancer knowledge and access to and utilization of quality breast health care for underserved women across the city. Strategic partnerships have been an invaluable resource for the organization. The aim of this study is to evaluate the programmatic impact of an academic-nonprofit partnership in improving breast health knowledge for women on Chicago's Southside. Citation Format: Beaulah Brent. [Advocate Abstract] Evaluating the impact of strategic partnerships [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B104.

Literacy of Breast Cancer and Screening Guideline in an Immigrant Group: Importance of Health Accessibility.

Little is known about predictors of breast cancer literacy among immigrant women. A cross-sectional survey investigated predisposing, enabling, and need factors of breast cancer literacy among 233 Korean American women living in a southeastern U.S. city. Breast cancer literacy was measured by questions that asked awareness of cancer screening methods and a 5-item questionnaire derived from the American Cancer Society's breast cancer screening guidelines and risk factors. Annual checkup was an enabling factor of awareness of Clinical Breast Exam (CBE) and mammogram, and also for breast cancer literacy covering the knowledge of breast cancer screening guidelines and risk factors. Health status was a need factor of CBE awareness. Marital status was a predisposing factor of mammogram awareness, and age and years of residence in the US were predisposing factors of breast cancer literacy. The findings of the study illuminate probable avenues of intervention to promote breast health knowledge for Korean American women.

Impact of Health Education Intervention on Breast Cancer Awareness among Rural Women of Tamil Nadu.

Background:The most common cancer among Indian females is breast cancer. Limited access to early detection and treatment is responsible for more than half of the deaths, primarily in rural areas, where organized mammography screening is neither affordable nor feasible. Therefore, imparting awareness on breast health and breast self-examination (BSE) is highly recommended. This study aimed to assess the impact of a health education interventional program on breast health awareness and BSE among rural women of Tamil Nadu.Methodology:A quasi-experimental study was conducted among 266 women. A preinterventional survey was done using a pretested validated questionnaire. A multipronged breast health education intervention was administered and its effectiveness was measured after 3 months using the same tool.Results:There was a statistically significant (P = 0.0001) improvement in the knowledge of breast health, perceived susceptibility, and reasons for practice and proficiency of BSE practice of the interventional group from pre- to post-test. After the interventional program, 71.8% of increase in knowledge about breast health and BSE was observed. In addition, 64.7% of the women practiced BSE compared to 7.14% pretest.Conclusion:This study highlights the awareness needs by the women and application of extensive strategies to increase the acceptance of cancer screening programs.

A Theoretical Approach to the Development of Instruments to Assess Knowledge and Beliefs of Breast Self-Awareness in Adolescent Females

ABSTRACTBackground: The American Academy of Pediatrics and the American Academy of Family Physicians recommends that breast health should be taught during the teen years. Purpose: The purpose of this paper is to describe the process of developing a revision of the Champion’s Health Belief Model Scale (CHBMS), appropriate for adolescent females, which measures knowledge and beliefs about breast cancer and BSE. Methods: This study employed the use of focus groups, an expert panel, and a pilot study to develop the Breast Health Knowledge Test and the Breast Health Beliefs Survey. Data analysis included descriptive statistics, test-retest reliability, and internal consistency of the instrumentation scales. Results: Results suggest that both of the instruments were valid and reliable. Discussion: Further research should be conducted on the female adolescent population to better understand their knowledge and beliefs on this topic. Translation to Health Education Practice: Health educators can design tailored interventions once adolescent knowledge and beliefs have been assessed using these instruments.A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

Making Breast Cancer (Black) History: Results of a Church-Based Primary Prevention Study

ABSTRACTBreast cancer rates for African American women are lower than that of their White peers, yet their mortality rate is disproportionately higher. This study sought to address the disparity through a community-based primary prevention study targeting African American women in the Black church utilizing the public health model of primary, secondary, and tertiary prevention. The study centered on the meaningful intersection of race, gender, and faith as key factors in increasing breast health knowledge and breast cancer risk factors. The results reveal that African American women respond positively to intervention models centered on salient aspects of their identity.

Awkward Choreographies from Cancer's Margins: Incommensurabilities of Biographical and Biomedical Knowledge in Sexual and/or Gender Minority Cancer Patients\u2019 Treatment

Canadian and American population-based research concerning sexual and/or gender minority populations provides evidence of persistent breast and gynecologic cancer-related health disparities and knowledge divides. The Cancer's Margins research investigates the complex intersections of sexual and/or gender marginality and incommensurabilities and improvisation in engagements with biographical and biomedical cancer knowledge. The study examines how sexuality and gender are intersectionally constitutive of complex biopolitical mappings of cancer health knowledge that shape knowledge access and its mobilization in health and treatment decision-making. Interviews were conducted with a diverse group (n=81) of sexual and/or gender minority breast or gynecologic cancer patients. The LGBQ//T2 cancer patient narratives we have analyzed document in fine grain detail how it is that sexual and/or gender minority cancer patients punctuate the otherwise lockstep assemblage of their cancer treatment decision-making with a persistent engagement in creative attempts to resist, thwart and otherwise manage the possibility of discrimination and likewise, the probability of institutional erasure in care settings. Our findings illustrate the demands that cancer places on LGBQ//T2 patients to choreograph access to, and mobilization of knowledge and care, across significantly distinct and sometimes incommensurable systems of knowledge.

Evaluation of Knowledge, Attitudes and Behaviors on the Breast Care of Patients and Health Care Personnels Who Apply to Family Medicine Policlinic

Objective: Breast cancer is the second most common cause of cancer-related mortality in women after lung cancer in the World. Early diagnosis and treatment is life-saving. Our aim with this study is to evaluate the knowledge, attitudes and behaviors of breast cancer awareness of health care professionals and patients who apply to our Family Medicine Policlinic in Eskisehir.Methods: A total of 424 female patients were included in the study. "Evaluation of the Knowledge, Attitudes and Behaviors of Breast Health of Patients and Healthcare Personnels Attending to the Family Physician Policlinic Form" which was prepared by the researchers was applied with a face-to-face interview method.Results: A total of 424 female patients were included in the study, 178 of them were health professionals. The average age was 40.2 ± 11.1 years. 54.1% (n= 153) of 283 patients who performed BSE were health care personnels and health care personnels’ performances of BSE were found to be statistically higher than non-health care personnels. 47.9% (n= 203) of participants in study are over 40 years of age and 66.5% (n= 135) of them are screened by mammogram, 33.5% (n= 68 ) of them did not have a mammogram. There was no significant difference about screened by mammography between health care personnels and non-health care personnels. Conclusion: While attending preventive health services, they should have positive attitudes towards developing health for health care personnel, which is also an example of cancer screenings.

A Breast Cancer Education Program for D/deaf Women.

Barriers to obtaining breast cancer prevention knowledge and breast cancer screening have been noted among D/deaf women. A randomized controlled trial (RCT) is described that tested a culturally and linguistically tailored breast cancer education program conducted among a racially/ethnically diverse sample of 209 D/deaf women age 40 years or older. The study focused on D/deaf women with no more than a secondary education, a population at relatively high risk for incomplete breast health knowledge and services. This population's inadequate breast cancer knowledge and screening practices and the value of the education program were confirmed. Knowledge increased from -baseline to 12-month follow-up in the intervention group, and in some instances the control group; increased intention to get a mammogram was observed in the intervention group. Possible reasons for the few significant intervention/control group differences at 12 months were examined. Materials from the RCT are available online.

Abstract P2-07-10: Breast health behaviors of women under 40 accessing the Avon breast health outreach program

Abstract Background Breast cancer is the most common cancer among women, and tends to be more aggressive when diagnosed in women &amp;lt;40 years. However, limited research exists on breast health behaviors of women &amp;lt;40. This study analyzes trends in breast health behaviors and diagnostic data among women &amp;lt;40 served by the Avon Breast Health Outreach Program (BHOP) which links medically underserved women to breast health education and screening services. Methods Confidential client intake records of female clients (n= 192,296) of Avon BHOP grantees continuously-funded from 2011-2015 were analyzed, along with breast cancer diagnosis data from a select number of clients (n=82) from January-March 2016. Results Approximately 7% of Avon BHOP clients from 2011-2015 were &amp;lt;40 years (n=12,872). Women &amp;lt;40 had a significantly lower odds of having been taught breast self-exam (BSE), knowing about mammograms before their visit, having had a clinical breast exam (CBE) in the past 2 years, and having had a mammogram in the past 2 years compared to women ≥40. Over 80% of women &amp;lt;40 reported being taught BSE and knowing about mammograms before their visit, compared to 94% among women ≥40. The percent who reported a CBE in the past 2 years increased by approximately 5% among both &amp;lt;40 and ≥40 women, to a high of 64.6% and 78.2%, respectively, in 2015. Reporting a mammogram in the past 2 years also increased by approximately 5% in both groups, to a high of 25.9% and 70.3%, respectively, in 2015. Women &amp;lt;40 had a significantly higher odds of having breast-related symptoms (OR=7.64) and a relative diagnosed with breast cancer (OR=1.23) compared to women ≥40. For women &amp;lt;40, the adjusted odds of having had a mammogram in the past 2 years were 1.34 times higher (p&amp;lt;0.001) among those who had a relative diagnosed with breast cancer compared to those who did not, while the odds were 1.09 (p&amp;lt;0.001) among women ≥40. From January-March 2016, 10 breast cancer cases in women &amp;lt;40 were reported by 7 Avon BHOP grantees; 38 cases were reported in women ≥40. Of the 10 diagnosed cases, the majority were Hispanic (70%) and 30% were Stage IV compared to 6% among women ≥40, however the difference was not statistically significant (p=0.096). Discussion In 2015 the American Cancer Society estimated that 4.2% of breast cancer cases were diagnosed in women &amp;lt;40. While the Avon BHOP diagnosis data is limited, the results nonetheless demonstrate a higher rate of breast cancer in this age group. Additionally, the association between being &amp;lt;40 and having a later stage diagnosis compared to those ≥40 appears to be a meaningful trend, and, while not significant in our preliminary data, we anticipate the finding to persist. While Avon BHOP clients &amp;lt;40 had a significantly lower odds of knowing about screening behaviors compared to ≥40, a large percentage had knowledge of breast health, and increasingly reported higher rates of screening behaviors. There was also a greater positive association between having a relative with breast cancer and having had a mammogram in the past 2 years in women &amp;lt;40 compared to ≥40. These findings suggest that Avon BHOP clients &amp;lt;40 increasingly understand their breast cancer risk and seek screening services accordingly. It is important to provide clear screening guidelines for this population. Citation Format: Gates-Ferris K, Bauer KM, Senter L. Breast health behaviors of women under 40 accessing the Avon breast health outreach program [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-07-10.

Abstract P4-17-05: A school-based breast health (BH) educational program to increase breast cancer awareness in a rural Mexican community: A qualitative comparative analysis of students', relatives' and teachers' perceptions

Abstract Background: In order to increase breast cancer awareness, we implemented a school-based educational program for female adolescents in a rural Mexican community, aimed at increasing knowledge and promoting intergenerational transmission of information to their female relatives. Here we report the perspective of the students, their female relatives and the school teachers on the program's impact on the adolescents and their community, as well as the major emergent themes related its implementation. Methods: Adolescents enrolled in a public rural Mexican middle school were invited to participate in the program. They received age-appropriate, culturally sensitive sessions from expert educators focused on transmitting BH knowledge in their household. The students' opinions of the program were evaluated using open ended questions immediately after its completion. The opinion of the students' female family members and of the school teachers were recorded four months after the intervention using open ended surveys and semi-structured interviews. The interviews were conducted at the school by two oncologists who designed and implemented the program and were recorded in video and audio formats. Data was coded using a narrative research approach, and a constructivist paradigm was used to explore emerging themes. NVivo software was used for qualitative data analysis. Results: The surveys were answered by 126 students, 185 family members and 18 teachers. Seven teachers then participated in semi-structured interviews. The following major themes were identified as related with the BH educational program by students: (1) the importance of breast self-examination; (2) the power obtained through knowledge and learning; and (3) the importance of disseminating the obtained information. The following major themes were identified by female relatives: (1) the importance of disease prevention; (2) knowledge to perform self-examination and seek medical attention and (3) empowerment through information. An analysis of the teachers' opinions identified the following major themes: (1) the program aided in discussing intimate topics; (2) the relevance of disseminating information in the community; (3) training other teachers and survivors for implementation; and (4) the importance of the acquisition of new knowledge. The relevance of obtaining and disseminating new knowledge was a common emerging theme among the three groups. Interestingly, both the students and their relatives highlighted the power of knowledge in empowering women and allowing them to prevent diseases and take care of their own health. Conclusions: Obtaining feedback from the relevant stakeholders and promoting active participation of the community is essential for the implementation of successful school-based education programs in cancer. We identified relevant themes related to BH education which could be useful for designing and implementing future programs. Providing adolescents from underserved populations with new knowledge and tools to take care of their health can empower them and aid them not only in preventing disease but in disseminating that knowledge in their communities. Citation Format: Soto-Perez-de-Celis E, Rojo-Castillo MP, Chavarri-Guerra Y. A school-based breast health (BH) educational program to increase breast cancer awareness in a rural Mexican community: A qualitative comparative analysis of students', relatives' and teachers' perceptions [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-17-05.

Effects of a web-based intervention on women's breast health behaviors.

Helping women make choices to reduce cancer risk and to improve breast health behaviors is important, but the best ways to reach more people with intervention assistance is not known. To test the efficacy of a web-based intervention designed to help women make better breast health choices, we adapted our previously tested, successful breast health intervention package to be delivered on the Internet, and then we tested it in a randomized trial. We recruited women from the general public to be randomized to either an active intervention group or a delayed intervention control group. The intervention consisted of a specialized website providing tailored and personalized risk information to all participants, followed by offers of additional support if needed. Follow-up at one-year post randomization revealed significant improvements in mammography screening in intervention women compared with control women (improvement of 13 percentage points). The intervention effects were more powerful in women who increased breast health knowledge and decreased cancer worry during intervention. These data indicate that increases in mammography can be accomplished in population-based mostly insured samples by implementing this simple, low resource intensive intervention.