Increase Breast Cancer Screening Research Articles

CN41 The RES-project, an on-going intervention aimed at increasing breast cancer screening attendance, among socioeconomically challenged groups

CN41 The RES-project, an on-going intervention aimed at increasing breast cancer screening attendance, among socioeconomically challenged groups

Effectiveness of communication in promoting utilisation of breast cancer screening services among women working in Anganwadi centres.

Breast cancer is the most common cancer among females, worldwide. Cancer screening in developing countries is mainly opportunistic type, characterized by low coverage and over-screening of women with increased access to health care services. This study was thus designed to understand the various factors preventing the participation and utilization of breast cancer screening, thereby study the different approaches for encouraging their participation and also the effectiveness of different ways of communication to Anganwadi Workers (AWW) and Anganwadi Helpers (AWH) in increasing breast cancer screening uptake at cancer screening camps. It was a mixed-method study design among Anganwadi workers and helpers. The study included 376 Anganwadi workers working in Kolar and Bangarpete Talukas. The trained Anganwadi supervisor followed by the respective PHC medical officer (in the intervention group) invited the AWW and AWH for breast cancer screening and only through Anganwadi supervisor (in control group). Those women (AWW and AWH) who did not attend the breast cancer screening camp were listed and contacted through mobile phone to find out the reasons for the same. The data were analysed using SPSS statistics version 22; Chi-square and logistic regression were used to test significance. There were 186 subjects in the intervention and 190 subjects in the control group. The mean (SD) age in intervention and control groups was 43.7 (8.5) and 44.2 (8.7) years, respectively. Amongst the 376 women (AWW and AWH) invited for the breast cancer screening service from both the groups, a total of 238 (63.2%) of them attended screening camp. The screening uptake was more in the intervention group (73.4%) compared with the control group (53.6%). This difference across the two groups (20%) was found to be statistically significant. The sub-category 'anxiety' (31.9%) was reported to be the highest barrier and least was in the sub-category 'no replacement' (4.3%). The sub-categories are also supported by verbatim quotes. The uptake of screening was more in the intervention group (73.4%) compared with the control group (53.6%). This difference of 20% was found to be statistically significant on univariate analysis (P < 0.001). After adjusting for confounders, it was found that both the approaches were equally effective.

Factors Affecting Breast Cancer Screening in Ukraine

PURPOSE Breast cancer early detection in Ukraine and other low and middle-income countries (LMICs) often includes opportunistic screening. Evaluation of factors that affect screening is key to improving early detection. METHODS An online survey for primary care physicians (PCPs) was distributed through PCP-focused social media in Ukraine. Data were analyzed using descriptive statistics. RESULTS 435 PCPs from all regions of Ukraine completed the survey, including 389 (89.4%) women, 375 (86.2%) family medicine, 60 (13.8%) internal medicine physicians. 349 (80.2%) referred women for screening mammography. 252 (57.9%) conducted screening clinical breast exams (CBE), while 135 (31.0%) referred patients to mammalogists or 133 (30.6%) to gynecologists for CBE. Within one's practice, mammography was available for 81 (18.6%), mammalogists for 39 (9.0%), and gynecologists for 133 (30.3%). Breast cancer screening was prompted by MOH Order 504 for 281 (64%), family history 266 (61%), patient pathway guidelines 94 (21.6%), availability of subspecialists 78 (17.9%), and patient request 132 (30%). Reasons for not conducting CBE screening included insufficient experience 88 (20.2%), patients declining CBE 63 (14.5%), lack of time 59 (13.6%). Reasons for not conducting mammography screening included patients declining (11.7%) and absence of mammography (6.4%).). 350 (80.5%) were familiar with the Ministry of Health (MOH) Order 504, which describes eligibility criteria for breast cancer screening, and 291 (66.9%) used it to guide their screening practice. Others used US or European recommendations (62 (14.3%) and 115 (26.4%), respectively), and institution-specific patient pathways 117 (26.9%). Barriers to breast cancer screening included insufficient PCP training (53%) and experience (40%) and insufficient mammography availability (33%). Strategies for increasing breast cancer screening included improving collaboration between PCPs and oncologists 175 (40.2%), educational materials for patients 169 (38.9%), PCP education/training 168 (38.6%), automatic electronic health record reminders 150 (34.5%). CONCLUSION We identified important barriers and facilitators of breast cancer screening from the point of view of PCPs in Ukraine. Our results were limited by online convenience sampling.

Dissemination and implementation science frameworks and strategies to increase breast cancer screening for at-risk women in the United States: A scoping review.

Dissemination and implementation science (D&I) can help bridge the gap between research and practice by addressing how to facilitate and maintain pre-existing evidence-based interventions (EBIs) in various contexts within different fields, including that of breast cancer screening and treatment. Yet, despite the availability of D&I frameworks and strategies, there is a lack of studies exploring knowledge transfer dissemination and implementation models, strategies, and frameworks in the setting of breast cancer care. There is a need for studies that create guidelines and roadmaps built on theoretical foundations of D&I research to scale up successful D&I of strategies, frameworks, and protocols proven to cater to the needs of all breast cancer patients when seeking screening and treatment services. The Arksey and O'Malley (2005) York methodology was used as guidance for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; (5) collating, summarizing, and reporting results. Most cited barriers (n = 46) sorted into the category of "Recruitment, Measurement, and Delivery Challenges." The predominant ERIC strategy, featured in a noteworthy 84% of studies, was "Tailor strategies" (#16), which belongs to the "Adapt and tailor to context: culture, language, data analysis, collection" domain. This study can guide researchers, physicians, and community workers in improving accessibility, affordability, and quality of breast cancer screening and adequate follow-up opportunities through D&I strategies and models improving the reach and sustainability of evidence-based programs in at-risk female populations.

Expansion of outreach to native Hawaii and Pacific Islander communities to increase breast cancer screening and clinical trial awareness in underserved and rural Oahu.

e13725 Background: Multiple barriers exist in the enrollment of racial and ethnic minority groups into breast cancer screening and clinical trials. Such barriers include the lack of knowledge, mistrust, and access. To increase participation of rural-dwelling Native Hawaiian/Pacific Islanders (NHPI) and other underserved minority groups in breast cancer screening and clinical trials, a pilot project was developed to augment community engagement, provide education, and gain insights into the cancer screening/clinical trial process. Our objective was to engage rural Oahu's underserved communities in breast cancer screening and facilitate enrollment into the Digital Tomosynthesis Mammography and Digital Mammography in Screening Patients of Breast Cancer Trial (TMIST) utilizing a team comprising of a cultural congruent and gender concordant Community Health Educator (CHE) and medical oncology health care provider. Methods: We reviewed the community activities over the course of a year. The CHE facilitated outreach by speaking at numerous church events and other community gatherings. Results: Participants did not respond favorably to surveys on social determinants of health. Common reasons for their reluctance included lack of perceived importance and medical mistrust. When discussing verbiage that was intimidating or confusing such as clinical trial protocol consent language, TMIST study participants conveyed a strong sense of dehumanization. Conclusions: A total of 93 women were screened for the TMIST clinical trial. Of those, 13 were enrolled in TMIST and 31 participants received mammograms. Participant insight highlighted the importance of education using culturally sensitive language and community engagement to combat the lack of knowledge and mistrust. Continued development of education materials centered around community involvement will improve the accrual of NHPI participation in breast cancer screening/clinical trials. We hope this project established a basis for equity in communities with low breast cancer screening and clinical trial participation rates. We intend to build upon the community partnerships forged during this pilot project.

Behavioral Interventions to Improve Breast Cancer Screening Outreach

Despite public health efforts, breast cancer screening rates remain below national goals. To evaluate whether bulk ordering, text messaging, and clinician endorsement increase breast cancer screening rates. Two concurrent, pragmatic, randomized clinical trials, each with a 2-by-2 factorial design, were conducted between October 25, 2021, and April 25, 2022, in 2 primary care regions of an academic health system. The trials included women aged 40 to 74 years with at least 1 primary care visit in the past 2 years who were eligible for breast cancer screening. Patients in trial A were randomized in a 1:1 ratio to receive a signed bulk order for mammogram or no order; in a factorial design, patients were concurrently randomized in a 1:1 ratio to receive or not receive text message reminders. Patients in trial B were randomized in a 1:1 ratio to receive a message signed by their primary care clinician (clinician endorsement) or from the organization (standard messaging); in a factorial design, patients were concurrently randomized in a 1:1 ratio to receive or not receive text message reminders. The primary outcome was the proportion of patients who completed a screening mammogram within 3 months. Among 24 632 patients included, the mean (SD) age was 60.4 (7.5) years. In trial A, at 3 months, 15.4% (95% CI, 14.6%-16.1%) of patients in the bulk order arm and 12.7% (95% CI, 12.1%-13.4%) in the no order arm completed a mammogram, showing a significant increase (absolute difference, 2.7%; 95% CI, 1.6%-3.6%; P < .001). In the text messaging comparison arms, 15.1% (95% CI, 14.3%-15.8%) of patients receiving a text message completed a mammogram compared with 13.0% (95% CI, 12.4%-13.7%) of those in the no text messaging arm, a significant increase (absolute difference of 2.1%; 95% CI, 1.0%-3.0%; P < .001). In trial B, at 3 months, 12.5% (95% CI, 11.3%-13.7%) of patients in the clinician endorsement arm completed a mammogram compared with 11.4% (95% CI, 10.3%-12.5%) of those in the standard messaging arm, which was not significant (absolute difference, 1.1%; 95% CI, -0.5% to 2.7%; P = .18). In the text messaging comparison arms, 13.2% (95% CI, 12.0%-14.4%) of patients receiving a text message completed a mammogram compared with 10.7% (95% CI, 9.7%-11.8%) of those in the no text messaging arm, a significant increase (absolute difference, 2.5%; 95% CI, 0.8%-4.0%; P = .003). These findings show that text messaging women after initial breast cancer screening outreach via either electronic portal or mailings, as well as bulk ordering with or without text messaging, can increase mammogram completion rates. ClinicalTrials.gov Identifier: NCT05089903.

Abstract CT272: A cluster randomized trial to evaluate a church-based navigation model to increase breast cancer screening in Korean women (Faith In Action!): Trial in progress

Abstract Background: Breast cancer is the most commonly diagnosed cancer among Korean American women and incidence in this group is rising. Advanced-stage disease is more frequent among Korean women diagnosed with breast cancer than in other ethnicities due to low adherence to screening. Lower socioeconomic status, cultural barriers, perceived norm, distrust of healthcare system, and lack of awareness and culturally tailored communication on benefits of screening contribute to low screening utilization. Church settings offer important platforms for education as a majority of Korean American women &amp;gt;50 years regularly attend church services. Thus, the objective of this trial was to evaluate the efficacy of a culturally tailored intervention “Faith in Action!” on breast cancer screening adherence rates among Korean American women. Methods: A parallel cluster randomized trial with staggered roll-out will be conducted to evaluate the efficacy of the “Faith in Action!” intervention, a church-based small group education and lay health navigator program, delivered by trained church members, on breast cancer screening among Korean American women (NCT05298605). This study was designed and conducted in partnership with a Community Advisory Board. Trial enrollment began in July 2022 and is ongoing. Twenty-four total Korean churches in Los Angeles were randomized within blocks of 8 churches to either intervention or waitlist control conditions in a 1:1 ratio. Using a train-the-trainer approach, lay navigators from the Korean Church community nominated by church leadership are trained and certified to deliver the Faith in Action! intervention to study participants over a 6-month program period. Participants at churches randomized to the waitlist control group receive an educational presentation on physical activity and nutrition and, after 6-month follow-up, are invited to receive the Faith in Action! intervention. Eligible participants include women of Korean descent, ages 45-75 years, who: attend a participating church, do not have a breast cancer diagnosis, and did not receive mammogram in the last 2 years. The primary outcome is adherence to breast cancer screening guidelines within 6 months from end of program. Secondary outcomes include adherence to breast cancer screening within 1 year and participant knowledge about breast cancer screening practices. Qualitative interviews will be conducted to assess participants’ knowledge and barriers surrounding cancer screening decisions and program acceptability. To date, 16 churches (149 total participants) have been enrolled in the study and are being followed. It is expected that findings from this research will inform community-based efforts to increase breast cancer screening adherence among Korean American women and improve understanding of screening barriers in this group that is disproportionately impacted by breast cancer, while building capacity and opportunities for sustainability in the Korean faith community. Citation Format: Gillian Gresham, Christie Y. Jeon, Dong Hee Kim, Min Jung Sung, Laurel J. Finster, Marcio A. Diniz, Michael Fine, Zul Surani, Alison K. Herrmann, Jeong Yup Lee, Robert W. Haile. A cluster randomized trial to evaluate a church-based navigation model to increase breast cancer screening in Korean women (Faith In Action!): Trial in progress [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT272.

231 (PB-138) Poster - Is awareness the most important factor in increasing breast cancer screening uptake?

231 (PB-138) Poster - Is awareness the most important factor in increasing breast cancer screening uptake?

The prevalence and predictors of clinical breast cancer screening in Sub-Saharan African countries: a multilevel analysis of Demographic Health Survey.

Despite a higher rate of breast cancer in sub-Saharan Africa (SSA), efforts to treat the disease through breast cancer screening are suboptimal, resulting in late diagnosis of breast cancer and poor outcomes. Several studies have been conducted in SSA countries about screening uptake, yet they addressed country or sub-country level data and did not consider both individual and beyond-individual factors related to screening. Hence, pooled prevalence as well as multilevel correlates of screening in the region is sparse, which have been addressed by this study using the most recent data among women with SSA. This study was conducted using the Demographic Health Survey data (2013-2022) from six countries, and a total weighted sample of 95,248 women was examined. STATA version 16 was used for the data analysis. Multilevel mixed-effects logistic regression was performed and significant predictors were reported using adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). The overall weighted prevalence of clinical breast cancer screening was 14.23% (95% CI: 13.97-14.75), with Namibia and Tanzania having the highest (24.5%) and lowest (5.19%) screening rates, respectively. Higher breast cancer screening uptake was observed among women of advanced age (35-49) [aOR = 1.78; 95% CI: 1.60, 1.98], had higher educational levels [aOR = 1.84; 95% CI: 1.66, 2.03], cohabited [aOR = 1.37; 95% CI: 1.21, 1.55], in the richest wealth quintile [aOR = 2.27; 95% CI: 1.95, 2.64], urban residents [aOR = 1.21; 95%CI: 1.10, 1.33], multiparous [aOR = 1.47; 95% CI: 1.30, 1.68], visited health facilities [aOR = 1.64; 95% CI: 1.52, 1.76], and read newspapers [aOR = 1.78; 95%CI: 1.60, 2.15]. The prevalence of clinical breast cancer screening was low (14%). Strengthening awareness campaigns, improving healthcare infrastructure, health education, universal health coverage, and screening program access, with a focus on rural areas, women who lack formal education, and low socioeconomic status, are critical to increasing breast cancer screening rates and equity. Scale-up local and regional collaborations and the involvement of media agencies in the implementation of screening programs, advocacy, dissemination of information, and integration of screening programs with their routine care, such as perinatal care, can boost the screening. The existing health service delivery points also need to focus on integrating breast cancer screening services with routine care such as perinatal care.

Development of a Digital Storytelling Intervention to Increase Breast, Cervical, and Colorectal Cancer Screening in the Hispanic/Latino Community: a Qualitative Evaluation.

Digital storytelling (DST) interventions may be one way to address disparities in cancer screening experienced by the Hispanic/Latino population. Digital stories are short, first-person narratives that include voice-over narration and images. With storytellers' permission, researchers can screen digital stories as a health intervention. Digital stories can inspire viewers to adopt or change their behavior, such as completing cancer screening. Rochester Healthy Community Partnership (a 20-year community-based participatory research partnership) together with eight Hispanic/Latino, Spanish speaking cancer survivors, co-survivors, or recently screened individuals, developed digital stories about breast, cervical, and colorectal cancer screening. Here, we describe our qualitative evaluation of the DST workshop. To understand what the storytellers thought viewers would find relatable in their digital stories, we applied Narrative Theory. We also assessed workshop successes and opportunities for improvement. We used the constant comparative method for data analysis. We learned that the storytellers anticipated their stories would be engaging and that viewers would connect with Hispanic/Latino cultural values. During the workshop, the storytellers felt like they were making an important contribution. The storytellers highlighted specific opportunities for improvement including sharing the stories more quickly after the workshop. Future research is needed to test whether this intervention follows the Narrative Theory causal pathway by persuading viewers to complete recommended cancer screenings.

Breast Cancer Screening Among Females With and Without Schizophrenia

Breast cancer screening with mammography is recommended in Ontario, Canada, for females 50 years or older. Females with schizophrenia are at higher risk of breast cancer, but in Ontario it is currently unknown whether breast cancer screening completion differs between those with vs without schizophrenia and whether primary care payment models are a factor. To compare breast cancer screening completion within 2 years after the 50th birthday among females with and without schizophrenia, and to identify the association between breast cancer screening completion and different primary care payment models. This case-control study analyzed Ontario-wide administrative data on females with and without schizophrenia who turned 50 years of age between January 1, 2010, and December 31, 2019. Those with schizophrenia (cases) were matched 1:10 to those without schizophrenia (controls) on local health integration network, income quintile, rural residence, birth dates, and weighted Aggregated Diagnosis Group score. Data analysis was performed from November 2021 to February 2023. Exposures were schizophrenia and primary care payment models. Outcomes included breast cancer screening completion among cases and controls within 2 years after their 50th birthday and the association with receipt of care from primary care physicians enrolled in different primary care payment models, which were analyzed using logistic regression and reported as odds ratios (ORs) and 95% CIs. The study included 11 631 females with schizophrenia who turned 50 years of age during the study period and a matched cohort of 115 959 females without schizophrenia, for a total of 127 590 patients. Overall, 69.3% of cases and 77.1% of controls had a mammogram within 2 years after their 50th birthday. Cases had lower odds of breast cancer screening completion within 2 years after their 50th birthday (OR, 0.67; 95% CI, 0.64-0.70). Cases who received care from a primary care physician in a fee-for-service (OR, 0.57; 95% CI, 0.53-0.60) or enhanced fee-for-service (OR, 0.79; 95% CI, 0.75-0.82) payment model had lower odds of having a mammogram than cases whose physicians were paid under a Family Health Team model. This case-control study found that, in Ontario, Canada, breast cancer screening completion was lower among females with schizophrenia, and differences from those without schizophrenia may partially be explained by differences in primary care payment models. Widening the availability of team-based primary care for females with schizophrenia may play a role in increased breast cancer screening rates.

Government Housing Assistance and Cancer Screening Among Adults With Low Income

Access to affordable housing may support cancer control for adults with low income by alleviating financial barriers to preventive care. This study examines relationships between cancer screening and receipt of government housing assistance among adults with low income. Data are from the 2019 and 2021 National Health Interview Survey. Eligible respondents were classified as up-to-date or not with breast cancer (BC), cervical cancer (CVC) and colorectal cancer (CRC) screening guidelines. Multivariable logistic regression was used to model guideline-concordant screening by receipt of government housing assistance, overall and stratified by urban-rural status, race/ethnicity, and age. Analyses were performed in 2023. Analyses for BC, CVC and CRC screening included 2,258, 3,132, and 3,233 respondents, respectively. There was no difference in CVC screening by housing assistance status, but screening for BC and CRC was higher among those who received assistance compared to those who did not (59.7% vs. 50.8%, p<0.01 for BC; 57.1% vs. 44.1%, p<0.01 for CRC). In models adjusted for sociodemographic characteristics, health status and insurance, these differences were not statistically significant for either BC or CRC screening. In stratified adjusted models, housing assistance was statistically significantly associated with increased BC screening in urban areas (aOR=1.35, 95% CI=1.00-1.82) and among Hispanic women (aOR=2.20, 95% CI=1.01-4.78) and women 45-54 years of age (aOR=2.10, 95% CI=1.17-3.75). Policies that address housing affordability may enhance access to BC screening for some subgroups, including women in urban areas, Hispanic women, and younger women. More research on the mechanisms that link housing assistance to BC screening is needed.

A Population Health Proposal for Increasing Breast Cancer Screening to Reduce Racial Disparities in Breast Cancer: Getting the Village Back Together.

A Population Health Proposal for Increasing Breast Cancer Screening to Reduce Racial Disparities in Breast Cancer: Getting the Village Back Together.

Evaluation of Family and Community Social Network Characteristics Among High-Risk Family Members to Improve Cancer-Related Health Behaviors.

To evaluate the effects of social network characteristics of individuals with a family history of cancer on the use of cancer-related services (e.g., screening, genetic counseling/testing). 170 family members of individuals with the most common hereditary or familial cancers. Data collection occurred between March and September 2021 using an online survey. Having strong within-immediate family relationships and family members who underwent more screening procedures was associated with increased breast cancer screening, and having more family members with cancer was associated with colorectal cancer screening. Having a large family, having family members who underwent screening for more cancers, and having strong social cohesion among families were associated with an increased rate of genetic testing. Nurses working with families affected by cancer should focus on strategies to strengthen relationships among family members to improve knowledge of cancer screening and available genetic services.

Knowledge of breast cancer, willingness and barriers to mammography screening among rural women in Enugu State, Nigeria.

Breast cancer is a serious public health threat. Mammography is the most reliable screening method that detects breast cancer early, enabling early onset of treatment which improves the prognosis of the disease. To determine women's knowledge of breast cancer, as well as barriers and willingness of women to participate in mammography screening. Using the cross-sectional survey design, we sampled and studied two rural communities of Enugu State, Nigeria. Two researcher-made questionnaires were used for the study. Frequencies, percentages, chi-square and regression analysis were employed in data analysis. Only 11.4 percent of study participants had good knowledge of breast cancer. There were significant differences in knowledge of breast cancer based on level of education (χ2 = 15.670; p =.001), monthly income (χ2 =6.954; p = .021) and ever screened (χ2 =5.242; p =.015). Lack of money (48.0%) and lack of knowledge (30.4%) were the most reported barriers to breast cancer screening. Women that had ever screened were 92.3% less likely willing to be screened than those never screened (aOR: .077, 95%CI .011-.522, p=.009). Health Education should be combined with improving women's economic status and subsidizing the cost of screening to increase breast cancer screening practice.

Comparative Effectiveness of 2 Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening Among Women in the Rural US

Women living in rural areas have lower rates of breast, cervical, and colorectal cancer screening compared with women living in urban settings. To assess the comparative effectiveness of (1) a mailed, tailored digital video disc (DVD) intervention; (2) a DVD intervention plus telephonic patient navigation (DVD/PN); and (3) usual care with simultaneously increased adherence to any breast, cervical, and colorectal cancer screening that was not up to date at baseline and to assess cost-effectiveness. This randomized clinical trial recruited and followed up women from rural Indiana and Ohio (community based) who were not up to date on any or all recommended cancer screenings. Participants were randomly assigned between November 28, 2016, and July 1, 2019, to 1 of 3 study groups (DVD, DVD/PN, or usual care). Statistical analyses were completed between August and December 2021 and between March and September 2022. The DVD interactively assessed and provided messages for health beliefs, including risk of developing the targeted cancers and barriers, benefits, and self-efficacy for obtaining the needed screenings. Patient navigators counseled women on barriers to obtaining screenings. The intervention simultaneously supported obtaining screening for all or any tests outside of guidelines at baseline. Receipt of any or all needed cancer screenings from baseline through 12 months, including breast, cervical, and colorectal cancer, and cost-effectiveness of the intervention. Binary logistic regression was used to compare the randomized groups on being up to date for all and any screenings at 12 months. The sample included 963 women aged 50 to 74 years (mean [SD] age, 58.6 [6.3] years). The DVD group had nearly twice the odds of those in the usual care group of obtaining all needed screenings (odds ratio [OR], 1.84; 95% CI, 1.02-3.43; P = .048), and the odds were nearly 6 times greater for DVD/PN vs usual care (OR, 5.69; 95% CI, 3.24-10.5; P < .001). The DVD/PN intervention (but not DVD alone) was significantly more effective than usual care (OR, 4.01; 95% CI, 2.60-6.28; P < .001) for promoting at least 1 (ie, any) of the needed screenings at 12 months. Cost-effectiveness per woman who was up to date was $14 462 in the DVD group and $10 638 in the DVD/PN group. In this randomized clinical trial of rural women who were not up to date with at least 1 of the recommended cancer screenings (breast, cervical, or colorectal), an intervention designed to simultaneously increase adherence to any or all of the 3 cancer screening tests was more effective than usual care, available at relatively modest costs, and able to be remotely delivered, demonstrating great potential for implementing an evidence-based intervention in remote areas of the midwestern US. ClinicalTrials.gov Identifier: NCT02795104.

Abstract 799: Measuring the impact of the COVID-19 pandemic on breast cancer screening in Puerto Rico

Abstract Introduction: The COVID-19 pandemic has caused major changes to healthcare services, especially those related to early detection and screening practices like breast cancer. In Puerto Rico, breast cancer is the main cause of death, representing 18.9% of cancer deaths in women, making early detection even more important to prevent morbidity and mortality. This study aims to describe the impact of COVID-19 on breast cancer screening and assess differences in health utilization by age group and health regions in Puerto Rico. Methods: This study used data on breast cancer screening medical claims from Puerto Rico Track, a project in collaboration with the Puerto Rico Public Health System and the Puerto Rico Institute of Statistics that aims to assess health access and utilization patterns in Puerto Rico. Claims including unilateral and bilateral mammography, sonommamography, and MRI were analyzed. Descriptive statistics and percentual changes between the COVID-19 baseline year (2016) compared with 2020 and 2021 were performed (overall, by age-group and health region). Results: A total of 193,793 screening tests were performed in 2016, compared to 66,463 in 2020, and 89,322 in 2021. Overall, a third of the medical claims for breast cancer screening (33.2%) were in the age group of 51-60 years. An overall decreasing percentual change was observed comparing 2016 vs. 2020 (65.7%), where the age group with the broadest gap reduction were among women 41-50 years old (68.2%). When comparing medical claims of 2016 (193,750) versus 2021 (89,320) (pre and post pandemic), an important decreasing change (53.9%) was observed. The age group with the highest decrease comparing 2016 to 2021 was the 41-50 years one (68.2%). The Western region of Mayagüez/Aguadilla had the highest decreasing percentual change, with a reduction of 73.6% in 2020 compared to 2016, and 62.6% when compared 2021 with 2016. Conclusion: Breast cancer screening was notably affected by the COVID-19 pandemic in Puerto Rico. A pattern of decreasing breast cancer screening was observed by health regions and by age. These efforts provide evidence of the need of tailored evidence-based interventions to increase breast cancer screening in the island. Citation Format: Vivian Colón-López, Hermilis Berrios Ortiz, Hector Contreras-Mora, Orville M. Disdier, Cynthia M. Pérez, Nilda Ríos, Olga L. Díaz, Juan Mejías, Erick L. Suárez-Pérez. Measuring the impact of the COVID-19 pandemic on breast cancer screening in Puerto Rico [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 799.

Effects of Educational Interventions in Facilitating Mammography Screening Among Asian American Women: A Meta-Analysis.

This meta-analysis evaluated the effects of various types of educational interventions on increasing breast cancer screening uptake among Asian American women. Web of Science, MEDLINE®, PubMed®, and Cochrane Library were searched for randomized controlled trials published from 2010 to 2020 of interventions developed to promote mammography uptake among Asian American women. A random-effects model was used to estimate pooled effect sizes using relative risk measures. A funnel plot was used to assess publication bias. Seven studies were included in this review. Educational interventions identified were primarily culturally sensitive approaches combined with access-enhancing, individually tailored, or group-based approaches. The interventions were effective at increasing the receipt of mammography. This review provides insight into the importance of combining other approaches with educational interventions to increase their effectiveness for Asian American women. Future interventions can incorporate various approaches to enhance the ability of Asian American women to overcome barriers to breast cancer screening.

Effectiveness of a Breast Cancer Education Screening and NavigaTion (BEST) Intervention among Hispanic Women.

In the United States, breast cancer remains one of the most diagnosed cancers among females and remains the second leading cause of cancer death. In addition, breast cancer is most likely diagnosed at an advanced stage among Hispanic females in the United States due to lower mammogram utilization. The objective of this study was to determine the effectiveness of a multilevel, multicomponent community-based breast cancer screening intervention called the Breast Cancer Education Screening and NavigaTion (BEST) program. The primary outcome was the completion of a screening mammogram 4 months post-intervention. We used a pragmatic approach for evaluation, utilizing a quasi-experimental delayed intervention design. We recruited women from the community aged between 50 and 75, uninsured or underinsured, and overdue for screening. Six hundred participants were recruited (300 intervention and 300 control). Among completers, the screening rate was 97% in the intervention group and 4.4% in the control group (RR = 22.2, 95% CI: 12.5-39.7, p < .001). In multivariable analysis, age ≥ 65 (RR = 1.29, p = .047), perceived benefits (RR = 1.04, p = .026), curability (RR = 1.24, p < .001), subjective norms (RR = 1.14, p = .014), and fatalism (RR = .96, p = .004) remained significantly associated with screening outcome. A multicomponent, bilingual, and culturally tailored intervention effectively facilitated breast cancer screening completion in an underserved population of Hispanic women. Individuals with improved screening outcomes were more likely to have higher positive beliefs. Our study has important implications regarding using multicomponent interventions in increasing breast cancer screening completion in poorly screened populations. It also highlights differences in health belief motivation for breast cancer screening completion.

Breast cancer screening adhesion among migrants: a matter of communication strategy?

Abstract Background Migrants’ engagement to cancer screening programs is a relevant issue for universalistic health systems. To increase breast cancer screening coverage among migrant women, a public-private partnership involving a multidisciplinary team of Primary Care, Public Health, Hospital and private social workers has been built up in a district in Italy. The team worked in two steps, planning health promotion (HP) meetings addressing women in refugees’ reception programs and a web-based workshop involving intercultural mediators (IMs) and community health promoters. Objectives The workshop, involving 10 professionals among IMs and community health promoters, realized in 3 online meetings during March ‘22, aimed at identifying communication tools to enable migrants’ participation to breast cancer screening and increasing health literacy (HL) and cultural competence (CC) among the team. A participatory approach, supported by learning methods, such as storytelling and role-play, has been adopted to identify the major barriers to access to screening and public health messages. Participants worked on critical words and concepts, highlighted during HP meetings, accounting for HL, literacy, language skills, communication techniques and different perspectives about health and prevention. Results Several barriers, such as lack of knowledge on preventive initiatives and different approaches to health, decrease the perception of cancer risk. Others, like family and work duties, influence the adhesion. Fear or shame about the exam and linguistic issues are further hampering factors. Participants pointed out text, audio and video messages, in Italian and native plain language, as useful tools to explain the screening procedure and give relevant and practical information supported by simple and clear illustrations to diffuse via WhatsApp. Conclusions The intervention enabled the team to improve HL and CC defining suitable communication strategies for cancer screening programs. Key messages