National Breast And Cervical Cancer Early Detection Program Research Articles

Abstract A154: Mammograms Across Missouri: A Qualitative Evaluation among Healthcare Providers to Improve Breast Cancer Screening in Rural Communities

Abstract Introduction: Breast cancer is the leading cause of cancer-related deaths among women, with rural communities having the highest rates of breast cancer mortality. Despite this burden, many women begin mammography later than recommended and the mammography screening rate remains low, with a previously reported declining trend, particularly among rural women compared to urban women. This study seeks to identify barriers to breast cancer screening and examine strategies to overcome these barriers in rural Missouri. Methods: In partnership with the Missouri Cancer Consortium and the Missouri Comprehensive Cancer Control Programs, we conducted key informant interviews with mammography health providers at health centers in each of ten counties with the highest breast cancer mortality and lowest screening mammography rates in Missouri. Semi-structured interviews included questions about seeking and delivering breast cancer screening as well as provider experiences with patient navigation, mobile mammography, and the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Data were analyzed using a deductive-inductive thematic approach in NVivo 14. Results: We conducted 14 interviews with health providers across 12 health sites. The majority of these sites used patient navigation (67%), mobile mammography (80%), and the CDC NBCCEDP (67%) as strategies to improve access to breast healthcare. Health providers frequently mentioned “no-shows” as a major challenge to providing breast healthcare, along with limited transportation, cost, fear, and competing work priorities as the major barriers faced by patients in seeking breast healthcare. Patient navigation and mobile mammography were beneficial in bringing breast healthcare closer to the community, while the CDC NBCCEDP covered screening and follow-up costs. The main facilitating factors to implementing these strategies were having dedicated staff and funding for patient navigation, and existing partnerships with other health institutions for mobile mammography. However, health providers identified several implementing challenges for the strategies. This included limited staff capacity and difficulty contacting or following up patients to schedule appointments for patient navigation and mobile mammography. For the CDC NBCCEDP, the challenges included difficulty identifying eligible patients and extensive paperwork in the enrollment process. Providers recommended increasing staff capacity to support patient navigation, using digital technology in identifying and enrolling women for the CDC NBCCEDP, and integrating mobile mammography with the CDC NBCCEDP to improve implementation efficiency. Discussion: The integration of multiple component strategies within breast healthcare may address the multi-level barriers women face in accessing breast cancer screening. This study contributes to the identification of organizational supports and informs development of policies needed to enhance the adoption and implementation of strategies that support the effective delivery of breast healthcare. Citation Format: Thembekile Shato, Carmen Vardeman, Sarah J. Chavez, Ashley C. Holmes, Joann Lee, Xarria Lewis, Katie Manga, Misty Phillips, Keisha Windham, Bettina F. Drake. Mammograms Across Missouri: A Qualitative Evaluation among Healthcare Providers to Improve Breast Cancer Screening in Rural Communities [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A154.

Changes in Screening Test Volume in the National Breast and Cervical Cancer Early Detection Program during the COVID-19 Pandemic, 2020-2022.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) observed significant declines in screening volume early in the COVID-19 pandemic, January-June 2020, with variation by race/ethnicity and geography. We aimed to determine how screening in the NBCCEDP recovered from these early declines as it is important for monitoring the long-term impact on women served by the program. Extending the previous analyses, we compared monthly breast (BC) and cervical cancer (CVC) screening volume in the NBCCEDP during 2020-2022, to five-year, pre-COVID-19 pandemic averages (2015-2019), and calculated percent change. Results were stratified by race/ethnicity and rurality groups. We employed multiple one-way ANOVA tests, which included multiple comparisons, to test for significant differences between groups. By December 2022, NBCCEDP breast and cervical cancer screening volumes had not fully recovered to pre-COVID-19 5-year averages, and recovery in breast cancer screening volume was slower than that of cervical cancer. Both BC and CVC screening among women in metro areas showed the smallest average monthly deficits (-8.8% BC and -4.9% CVC) compared to monthly pre-COVID-19 pandemic 5-year averages, and screening among women in rural areas showed the greatest deficits (-37.3% BC and -26.7% CVC). BC and CVC screening among Hispanic women showed the greatest improvements compared to the pre-COVID-19 averages (8.2% BC and 9.5% CVC), and cervical cancer screening among non-Hispanic Asian and Pacific Islander women showed the greatest deficits (-41.4% CVC). For increased intervention efforts, NBCCEDP recipients can focus on populations demonstrating greatest deficits in screening volume.

Barriers and Facilitators to Breast and Cervical Cancer Screenings for Hispanic Women in a Rural State

Abstract Introduction The Centers for Disease Control and Prevention (CDC) and the Division of Cancer Prevention of Control administer the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), designed to increase early detection of cancers among low-income uninsured and underinsured women. However, rates of cancer diagnosis and survivorship differ among women of different ethnicities. We investigated two questions: 1) what are the potential barriers and facilitators for women to complete recommended breast and cervical cancer screenings, and 2) are the barriers and facilitators different for Hispanic women when compared to non-Hispanic White women? Methods We used a community-based participatory research approach and mixed methods: qualitative interviews with women enrolled in the program and a systematic process improvement approach to identify root causes of completing or not completing screenings. We conducted semi-structured interviews in English (n = 11) and Spanish (n = 9) and analyzed responses using fishbone diagrams. Results We recruited 20 participants in four categories: (a) non-Hispanic White women who completed screenings (n = 9), (b) non-Hispanic White women who did not complete screenings (n = 2), (c) Hispanic women who completed screenings (n = 7), and (d) Hispanic women who did not complete screenings (n = 2). Among all women, facilitators included assistance from program staff with appointments and reminders. Hispanic women reported barriers including language difficulties and confusion about the program. Non-Hispanic White women identified barriers as confusion about the role of insurance. Conclusions We found that there are differences in barriers and facilitators for non-Hispanic White women and Hispanic women due to language, the role of insurance, and the level of trust in the program. Reasons for not completing screenings for Hispanic women were structural and systemic in nature; reasons for non-Hispanic White women were based on personal choices.

Primary human papillomavirus testing vs cotesting: clinical outcomes in populations with different disease prevalence.

Implementation of primary human papillomavirus (HPV) testing has been slow in the United States perhaps because of concerns of decreased sensitivity compared with concurrent HPV and cytology testing ("cotesting"). We used the National Breast and Cervical Cancer Early Detection Program and the Kaiser Permanente of Northern California cohort to quantify potential trade-offs with primary HPV compared with cotesting in 4 US populations with differing precancer or cancer prevalence. In all settings, cotesting required more lab tests and more colposcopies compared with primary HPV testing. Additional cervical intraepithelial neoplasia grade 3 or cancer immediately detected from cotesting vs primary HPV decreased with decreasing population-average cervical intraepithelial neoplasia grade 3 or cancer prevalence from 71 per 100 000 screened among never or rarely screened individuals in the National Breast and Cervical Cancer Early Detection Program (prevalence = 1212 per 100 000) to 4 per 100 000 screened among individuals with prior HPV-negative results in Kaiser Permanente of Northern California (prevalence = 86 per 100 000). These data suggest that cotesting confer an unfavorable benefit-to-harm ratio over primary HPV testing.

Are National Breast and Cervical Cancer Early Detection Program Recipients Providing Services in Counties Heavily Burdened by Breast and Cervical Cancer?

Alignment of National Breast and Cervical Cancer Early Detection Program (NBCCEDP) clinical services with the spatial distribution of breast and cervical cancer burden is essential to maximizing programmatic impact and addressing cancer disparities. This study identified spatial clustering of breast and cervical cancer burden scores and assessed whether and to what extent NBCCEDP clinical services were associated with clusters for the 5-year period, 2015-2019. We examined burden scores for spatial clustering using Local Indicators of Spatial Association (LISA) tests in GeoDA. We then used t-tests to compare the NBCCEDP 5-year average percentage of eligible women served clinical breast and cervical cancer services between hotspot (high burden) and coolspot clusters. There was statistically significant spatial clustering in the pattern of breast and cervical cancer burden scores across counties, with hotspot clusters mostly observed in the Southern region, Idaho and Nevada. For both breast and cervical cancer, higher percentages of eligible women received breast and cervical cancer clinical services in coolspot clusters compared to hotspot clusters during each year from 2015-2019. NBCCEDP clinical services can help reduce breast and cervical cancer burden. Yet, during 2015-2019, increased service delivery was not aligned with the spatial distribution of counties with greater breast and cervical cancer burdens. NBCCEDP recipients may improve their impact on breast and cervical cancer burden by prioritizing and consistently increasing service delivery in cancer burden hotspot clusters if they have not already maximized their resources in these areas.

Abstract C072: Statewide variability in predictors of survival among geographically and racially diverse breast cancer cohorts

Abstract Introduction The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides free breast cancer screening, case management, patient navigation, and connection to treatment for medically underserved and economically-disadvantaged women aged 40–64 years. The aim of this study was to identify differences in predictors of survival between all women diagnosed with breast cancer in South Carolina versus those enrolled in the SC NBCCEDP Methods We established a retrospective cohort of breast cancer patients diagnosed from 2004 to 2015 using the South Carolina Central Cancer Registry. Sociodemographic (e.g., race, age) and clinical variables were abstracted from the registry. We linked registry data to county-level variables to determine levels of social deprivation and residence in a health care professional shortage area using the Robert Graham Center’s Social Deprivation Index (SDI) and the Health Provider Shortage Area (HPSA) designation. Potential exposure variables (e.g., SDI, hormone receptor status, age, HER2 receptor status, time to first treatment, region, insurance status, cancer stage, year of diagnosis, rurality, NBCCEDP enrollment, race, marital status, cancer grade, HPSA designation) were entered into a Cox proportional hazard model to identify significant predictors of survival. The multivariable model utilized a backward elimination process to obtain the best fitting model at a p-value <0.05 for each cohort of survivors (NBCCDP participants and all other breast cancer survivors).Results A total of 34,518 breast cancer patients were diagnosed during this time out of which 873 (2.5 %) were NBCCEDP participants. Overall, there were nine significant predictors namely race, cancer stage, age, hormone receptor status, HER receptor, cancer grade, marital status, insurance status, and diagnosis year. Among NBCCEDP participants, there were four significant predictors namely cancer stage, age, hormone status, and region. Region was the only significant predictor variable unique to NBCCEDP participants with those living in the Midlands region having an adjusted hazard ratio of 1.8; 95% CI: 1.1-2.8 compared with participants who lived in Lowcountry region. Overall, in both cohorts, race was one of the significant independent predictor variables with Black women having an adjusted hazard ratio of 1.2; 95% CI: 1.1-1.3 compared with white women. Conclusions Survival was significantly poorer among NBCCEDP participants living in the Midlands region, and Black women overall. To reduce survival disparities and enhance efficiency of NBCCEDP, efforts directed at enhancing support and eliminating barriers to timely detection and treatment should be focused on NBCCEDP participants living in the Midlands region of the state and Black women generally. Citation Format: Oluwole A. Babatunde, Whitney E. Zahnd, Eric Adjei Boakye, Melanie S. Jefferson, Nosayaba Osazuwa-Peters, Chanita Hughes Halbert, Swann A. Adams. Statewide variability in predictors of survival among geographically and racially diverse breast cancer cohorts [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C072.

Abstract B060: Increasing breast and cervical cancer knowledge in the COVID-19 pandemic in the health system

Abstract The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) reported that for the month of In April 2020, screening tests for breast cancer decreased by 87% and for cervical cancer by 84% compared to the previous 5-year averages for that month. In response to this finding, the Puerto Rico Breast and Cervical Cancer Prevention and Early Detection Program (PR-BCCPEDP) in collaboration with the insurer Triple S-Salud, implemented a virtual educational intervention and/or face-to-face for breast and cervical cancer in the health centers where Triple-S Salud insurer provides services. The purpose of this initiative was aimed at strengthen knowledge in the early detection of breast and cervical cancer, increase the use of screening tests in the population of interest, and increase the reach of women who do not have health insurance who can qualify for the Program. Methodology: The PR-BCCPEDP entered into a collaborative agreement with the insurer Triple-S Salud to implement an educational intervention for breast and cervical cancer in 12 primary health centers around the island. In the period from October to December 2020, 12 health educators from the Triple-S Salud insurer carried out 131 educational activities with the participation of 875 participants. The educational activities were carried out in person through educational flip charts and virtually using an educational PowerPoint on both types of cancer. The educational materials included topics related to breast and cervical cancer such as: statistics, risk factors, signs and symptoms, early detection guidelines, myths and facts, and barriers to not having early detection tests. Results: The educational intervention in breast and cervical cancer obtained the following results: A total of 875 participated in the intervention, where 100% were women, with an average age of 50 years and the majority (97%) had coverage from the government health plan. The towns with the most registered participants were Bayamón with 18% and Mayagüez with 16% respectively. The virtual form was the most used by the participants (58%) compared to the face-to-face form. Regarding screening tests for breast and cervical cancer, of 75 women who had overdue the breast cancer guidelines, 20% had a mammogram after the intervention. Similarly, 142 women had overdue the cervical cancer guidelines, and 22.6% were carried out the tests after the intervention. Other hand, of the women, referred to the PR-BCCPEDP, 3% indicated not having health insurance, of which 29.6% were recruited and cared for by the Program. Conclusion: Despite security restrictions as a result of the pandemic, collaborations with a health system helped reach a greater number of women to provide education and awareness about breast and cervical cancer. In addition, it can be inferred that the virtual form allowed for increasing the scope of participation in times of pandemic. Lastly, I also helped reach women without health insurance who were recruited into the Program. Citation Format: Omayra Salgado-Cruz, Nelybeth Santiago-Yance, Mirza Rivera-Lugo, Guillermo Tortolero-Luna. Increasing breast and cervical cancer knowledge in the COVID-19 pandemic in the health system [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B060.

Retrenchment of Wisconsin’s Well Woman Program and changes in insurance coverage around the Affordable Care Act

Since before the Affordable Care Act (ACA), states have partnered with the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to support access to cancer screening and treatment for uninsured/underinsured women. The Wisconsin Well Woman Program (WWWP) was one such program, supporting low-income women across the state. With ACA introduction, Wisconsin substantially downsized/restructured the WWWP, expecting the reduction in services to be offset by the rise in ACA-provided insurance coverage. This study assesses whether retrenchment in the WWWP following the ACA indeed prompted a differential rise in insurance coverage among the program’s target population. We use a difference-in-differences (DID) design to contrast changes in county-level, target-population insurance rates, over 2008–2018, in Wisconsin counties previously most served by the WWWP vs those least served, adjusting for systematic differences across counties, including pre-policy trends. Pre-ACA (2011–2013), most-served counties had lower insurance rates by 2.5 percentage points (pp) than least-served counties; WWWP services likely compensated for some of that gap. In 2014–2015, along with WWWP’s steep contraction, insurance rates rose sharply across all counties. Our primary DID analysis and event study suggest that WWWP contraction might have differentially driven more insurance take-up in most-served counties, by 1.88 pp [95 % Confidence Interval: 0.23,3.54], thus narrowing the pre-ACA gap. Sensitivity analyses suggest much smaller gains. Notwithstanding such potential insurance gains following program contraction, continued support for care navigation and coordination remain necessary to truly meet the needs of the vulnerable women previously served by the WWWP and similar programs across states.

Geographic Examination of COVID-19 Test Percent Positivity and Proportional Change in Cancer Screening Volume, National Breast and Cervical Cancer Early Detection Program.

IntroductionIn 2020, the COVID-19 pandemic led to significant declines in cancer screening, including among women served by the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This study examined the spatial association between state-based COVID-19 test percent positivity and proportional change in NBCCEDP screening volume.MethodsUsing the COVID-19 Diagnostic Laboratory Testing dataset, we calculated state-based monthly COVID-19 test percent positivity from July through December 2020 and categorized rates into low, medium, and high groups. We used data from 48 NBCCEDP state awardees to calculate the state-based monthly proportional change in screening volume and compared data for July–December 2020 with the previous 5-year average for those months. We categorized changes in screening volume into large decrease, medium decrease, and minimal change and created maps of the associations between variable subgroups by using bivariate mapping in QGIS.ResultsBivariate relationships between COVID-19 test percent positivity and proportional change in cancer screening volume varied over time and geography. In 5 of 6 months, 4 states had high COVID-19 test percent positivity and minimal change in breast or cervical cancer screening volume; 2 states had high COVID-19 test percent positivity and minimal change in breast and cervical cancer screening volume.ConclusionSome states maintained pre–COVID-19 screening volumes despite high COVID-19 test percent positivity. Follow-up research will be conducted to determine how these states differ from those with consistent decreases in screening volume and identify factors that may have contributed to differences. This information could be useful for planning to maximize NBCCEDP awardees’ ability to maintain screening volume during future public health emergencies.

An update to a retrospective comparison of results between the National Breast and Cervical Cancer Early Detection Program and NCI cancer center based early detection program with evidenced based patient navigation and social work support.

e18572 Background: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) through the CDC has provided uninsured women access to breast and cervical cancer screening/diagnostic services. The uninsured face obstacles which include fear, lack of access and trust in the system, financial and logistical barriers to accessing health care services (Natale-Pereira, et.al, 2011) Disparities in access to screening and diagnostic testing, cancer treatment and survivorship is well documented for medically vulnerable populations that impact stage of diagnosis and mortality (Guadagnolo, Dohan & Raich 2011). The Jefferson's program participates in the NBCCEDP program and uses other private resources which incorporate Social Work core competencies that provide assistance to address barriers. The program navigates along the continuum of cancer care (e.g, prevention, screening, treatment and survival). We have found in a comparative analysis that TJUH’s program has higher rates of diverse racial and ethnic participation of key medically underserved demographics than the National Program. Methods: TJUH's program employs a clinical model, Clinical Patient Navigation with a Licensed Clinical Social Worker operating from a strengths based framework to direct care with administrative support. The program utilizes best practices for working with the at risk population: translation services for the Limited English Proficient, appointment confirmation, transportation assistance and psychosocial support from initial point of contact through final diagnosis. Program staff coordinate internal and external referrals from multiple providers. Results: The study population includes 3144 participants who received breast and cervical cancer screening services through the program from 2012 through 2020. 13.9% were white, 41.7% were African-American, 24.5% were Asian and 19.1% Latinx participated in the program, Table. The age of the participants was slightly younger than the National program as well with 15% under 40, 46% between the ages of 40-49. Conclusions: TJUH’s program provides comprehensive psychosocial support to address barriers along the continuum of screening and diagnostic services leading with increased participation among at risk populations. This further reduces no show rates and participants being lost to follow up. TJUH’s program screens a larger proportion of African American and Asian and younger women compared to the NBCCED program. Additionally, we serviced a slightly younger population than the national program. TJUH’s program addresses health disparities and inequity in access to cancer screening services as shown by the data of the diversity of the participants.

Role of Medicaid in Early Detection of Screening-Amenable Cancers.

This study examines the association between Medicaid enrollment, including through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), and distant stage for three screening-amenable cancers: breast, cervical, and colorectal. We use the Surveillance, Epidemiology, and End Results Cancer Registry linked with Medicaid enrollment data to compare patients who were Medicaid insured with patients who were not Medicaid insured. We estimate the likelihood of distant stage at diagnosis using logistic regression. Medicaid enrollment following diagnosis was associated with the highest likelihood of distant stage. Medicaid enrollment through NBCCEDP did not mitigate the likelihood of distant stage disease relative to Medicaid enrollment prior to diagnosis. Non-Hispanic Black patients had a greater likelihood of distant stage breast and colorectal cancer. Residing in higher socioeconomic areas was associated with a lower likelihood of distant stage breast cancer. Medicaid enrollment prior to diagnosis is associated with a lower likelihood of distant stage in screen amenable cancers but does not fully ameliorate disparities. Our study highlights the importance of health insurance coverage prior to diagnosis and demonstrates that while targeted programs such as the NBCCEDP provide critical access to screening, they are not a substitute for comprehensive insurance coverage.

Abstract PO-257: Prevalence and correlates of false-positive results in screening mammography among uninsured women in a community outreach program

Abstract Introduction: False-positive mammographic screening results are one of the most important harms of breast cancer screening, and their prevalence in the insured population range from 8.7% to 16.3% during the first screening encounter. However, false-positive results have been rarely investigated among uninsured minority women screened through community outreach programs. For this study, we analyzed data from the Breast Screening and Patient Navigation (BSPAN) program participants with an aim to report prevalence and assess correlates of false-positive results in screening mammograms, stratified by age. Methods: BSPAN, created by Moncrief Cancer Institute, contracts with the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and uses a hub-and-spoke model to provide patient navigation and no-cost breast cancer screening and diagnostic services to under- and uninsured predominantly minority women in North Texas. We defined false-positive result as a positive screening mammogram (BI-RADS 0, 3, 4 or 5) followed by a negative diagnostic mammogram (BI-RADS 1, 2 or 3) or a negative biopsy within 9 months of the screen. We used multivariable logistic regression to assess associations of demographic and clinical covariates with false positive results for each age group (40-49 years and 50-64 years, which coincides with age eligibility for NBCCEDP). Results: BSPAN provided screening services to 21,022 women between 2012 and 2019. Prevalence of false-positive results in these women was 11.8% in the 40-49 age group and 9.6% in the 50-64 age group. Multivariable logistic regression demonstrated that, in the 40-49 age group, women who were non-menopausal, did not use hormone replacement therapy, and had prior mammograms had higher odds of false-positive results than those who were menopausal, used hormone replacement therapy and had no prior mammograms, respectively. In the 50-64 age group, women with a prior diagnostic mammogram had higher odds of false-positive results than those without a prior diagnostic mammogram. Discussion: This study establishes contemporary evidence regarding prevalence and correlates of false-positive rates in the unique BSPAN population, where women were predominantly Hispanic, under- and uninsured receiving no-cost screening and diagnostic services through a real-world outreach program. Our findings demonstrate that uninsured women who receive no-cost mammograms are similar to insured women in two aspects: prevalence of false-positive rates in our study is comparable to those among insured population, and we found higher false positive rates among younger women, compared to older women. Impact: Equitable screening outcomes in underserved population emphasizes the need for efforts to reduce false-positive screening rates among uninsured women served through community outreach programs. Citation Format: Rasmi G. Nair, Simon J. Craddock Lee, Hong Zhu, Firouzeh K. Arjmandi, Emily Berry, Keith E. Argenbright, Jasmin A. Tiro, Celette S Skinner. Prevalence and correlates of false-positive results in screening mammography among uninsured women in a community outreach program [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-257.

Abstract PO-065: Increasing breast and cervical cancer knowledge during COVID-19 pandemic in collaboration with Cooperative Extension Program

Abstract Introduction: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of the Centers for Disease Control and Prevention (CDC) reported that in April 2020, screening tests for breast cancer decreased by 87% and 84% for cervical cancer, compared to the averages of the previous 5-year for the same month. In response to this finding, the Puerto Rico Breast and Cervical Cancer Prevention and Early Detection Program (PR-BCCPEDP), in collaboration with the Cooperative Extension Program (CEP), implemented an educational intervention of breast and cervical cancer in the northeast region of the island. The intervention aimed to reinforce knowledge in the early detection of breast and cervical cancer, increase screening tests, and reach out to women without health insurance who may qualify for the Program. Methodology: Since 2017, the PR-BCCPEDP agreed with the CEP to implement educational interventions for breast and cervical cancer in 4 of CEP's regions throughout the island. From February to May 2021, seven CEP Family and Consumer Educators (EFC) carried out 8 educational activities with 182 participants in the island's northeast region. We collected age, town of residence, level of education, health insurance, breast and cervical cancer screening history, and the reasons for not having performed screening tests according to the recommended guidelines. The educational activities were performed virtually through an educational PowerPoint and face-to-face using flip charts. The topics included breast and cervical cancer statistics, risk factors, symptoms, early detection guidelines, myths and facts, and barriers to not having screening tests. Participants that didn't have the screening tests according to the recommended guidelines had follow-up calls. Results: A total of 182 women participated in the intervention, with an average age of 47 years; most participants had a high school degree (42%), and 59% had the government's health plan. Regarding screening tests, 35.1% reported that they had not had a mammogram in the last two years, 73.4% authorized to be contacted after the intervention. Similarly, Pap tests, 30.7% reported that they had not had a Pap test in the last three years, of which 87.5% authorized to be contacted. Of the participants who had not had a mammogram (35.1%) or Pap test (30.7%), the main reason was the COVID-19 Pandemic (22.9% and 21.8%, respectively). Regarding the participants referred to the PR-BCCPEDP, 3.6% of the women without health insurance were referred to the Program and of these, 50% were recruited. Conclusion: Despite security, restrictions from the Pandemic, collaborations with community-based programs helped to reach a greater number of women to provide education and awareness about breast and cervical cancer. In terms of breast and cervical cancer screening, more than a third of the participants had not had their mammogram or Pap done due to the Pandemic. Women were recruited for the Program; however, additional efforts are necessary in order to reach a higher number of uninsured women. Citation Format: Omayra Salgado, Ircha Martinez, Nelybeth Santiago, Mirza Rivera, Taina De La Torre, Guillermo Tortolero. Increasing breast and cervical cancer knowledge during COVID-19 pandemic in collaboration with Cooperative Extension Program [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-065.

Hispanic Ethnicity and Cervical Cancer Precursors Among Low-Income Women in Arizona.

PurposeIn the United States, Hispanics are more likely to be diagnosed with cervical cancer compared to Non-Hispanic Whites. Annually, 250,000 to 1 million women are diagnosed with a precursor to CC. The aim of this study was to assess whether Hispanics have a higher prevalence of cervical dysplasia compared to Non-Hispanics Whites among a population of low-income women.Patients and MethodsWe analyzed the results of 10,911 cervical cytology tests administered between 2003 and 2016 that were funded through the Center for Disease Control and Prevention’s (CDC) program for low-income, uninsured women entitled the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). In the state of Arizona, the program is called the Well Women HealthCheck Program (WWHP). Logistic regression was used to identify increased risk of dysplasia, including low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL/ICC), and multinomial logistic regression was used to assess increased likelihood for LSIL and HSIL/ICC as separate categories.ResultsIn the crude analysis, Hispanic ethnicity was modestly associated with higher prevalence of LSIL (odds ratio (OR)=1.39, 95% CI=1.01–1.91), but this association was not statistically significant after adjusting for confounders. However, in the final models, lower income was independently associated with LSIL (adjusted odds ratio [aOR]=1.55, 95% CI=1.30–1.44), while smoking (aOR=2.88, 95% CI=1.21–6.84) and no history of Pap test within five years (aOR=3.54, 95% CI=1.61–6.99) were independently associated with HSIL.ConclusionAfter adjusting for confounding in a sample of low-income women with comparable Pap screening rates, ethnicity was not associated with greater prevalence of abnormal pap smears. However, other variables were independently associated with LSIL and HSIL. The higher proportion of LSIL cases among lower income individuals compared to those with higher incomes, and the higher proportion of HSIL cases observed among those screened least regularly stresses the importance of programs like WWHP: programs that target low-income, uninsured women. These programs help save lives.

COVID-19 impact on screening test volume through the National Breast and Cervical Cancer early detection program, January–June 2020, in the United States

Women from racial and ethnic minority groups face a disproportionate burden of cervical and breast cancers in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic might exacerbate these disparities as supply and demand for screening services are reduced. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening services to women with low income and inadequate health insurance. We examined COVID-19's impact on NBCCEDP screening services during January-June 2020. We found the total number of NBCCEDP-funded breast and cervical cancer screening tests declined by 87% and 84%, respectively, during April 2020 compared with the previous 5-year averages for that month. The extent of declines varied by geography, race/ethnicity, and rurality. In April 2020, screening test volume declined most severely in Health and Human Services Region 2 - New York (96% for breast, 95% for cervical cancer screening) compared to the previous 5-year averages. The greatest declines were among American Indian/Alaskan Native women for breast cancer screening (98%) and Asian Pacific Islander women for cervical cancer screening (92%). Test volume began to recover in May and, by June 2020, NBCCEDP breast and cervical cancer screening test volume was 39% and 40% below the 5-year average for that month, respectively. However, breast cancer screening remained over 50% below the 5-year average among women in rural areas. NBCCEDP programs reported assisting health care providers resume screening.

Novel mapping methods to describe utilization of free breast cancer screening from a state program

IntroductionThe National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is a cancer screening program whose mission is to reduce cancer morbidities for uninsured and underinsured women. A primary activity is to connect women to breast cancer screening. The eligible population and utilization of NBCCEDP screening services have never been quantified at a sub-state level, which hampers effective program evaluation. Here, the Minnesota NBCCEDP, “Sage”, serves as a case study to demonstrate novel spatial analysis methods that depict variation of screening rates at the local level.MethodsWomen who received breast cancer screening through Sage between 2011 and 2015 were geocoded (N = 74,712 screenings); analysis occurred between 2017 and 2019. We determine an eligible population using a synthetic population dataset that provides geographic residence and demographic information. We introduce a novel spatial analysis technique, spatially adaptive filters (SAFs), to create a utilization map of Sage breast screening services by Minnesota women.ResultsBetween 2011 and 2015, an average of 36,979 women per year were eligible for NBCCEDP breast cancer screening services, representing 3% of the Minnesota female population 40 and older. For Minnesota NBCCEDP eligible women, the state average breast cancer screening utilization rate was 37.2%, but varied considerably by local regions within the state (range 0% to 131%, SD = 18.7%).ConclusionsThis geospatial model estimated screening service utilization at the local level and enables Minnesota’s Sage program to target specific areas they have yet to reach. Similar programs could employ this model to direct program activities.

Time from breast cancer diagnosis to treatment among Idaho's National Breast and Cervical Cancer Early Detection Program population, 2011-2017.

Idaho's Women's Health Check (WHC) Program provides breast and cervical cancer screening to under- and uninsured women via funding from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Because WHC serves populations with less access to health care, this study evaluated time from breast cancer diagnosis to treatment for women enrolled in the WHC program and linked to Cancer Data Registry of Idaho (CDRI) case data (WHC-linked) and the remainder of female Idaho resident breast cases. Among Idaho residents aged 50-64years diagnosed during 2011-2017 with ductal carcinoma in situ or invasive breast cancer, we assessed differences in the median time from definitive diagnosis to treatment initiation overall and by demographic and tumor characteristics, and differences in the distribution of demographic and tumor-related variables between 231 WHC-linked and 3,040 non-linked breast cancer cases. WHC-linked cases were significantly less likely to be non-Hispanic white, and more likely to live in poorer census tracts, be diagnosed at a later stage, and be treated with mastectomy. Most WHC-linked (92%) and non-linked women (94%) began treatment within 60days of diagnosis; no differences in time to treatment were observed. Disparities in the interval from definitive diagnosis to breast cancer treatment initiation were not observed for women enrolled in the WHC program relative to other Idaho women.

Predictors of timely diagnostic follow-up after an abnormal Pap test among Hispanic women seeking care in El Paso, Texas

BackgroundDiagnostic follow-up of women with an abnormal Pap test is necessary to resolve the risk developing cervical cancer. The purpose of this study is to describe patient characteristics associated with timely receipt of a diagnostic colposcopy after an abnormal Pap test among Hispanic women in El Paso, a Texas-Mexico border city.MethodsWe conducted a retrospective chart review of Hispanic patients seen at an academic colposcopy clinic following an abnormal Pap test. An optimal diagnostic interval to colposcopy was based on a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) quality indicator and was defined as receipt of colposcopy within 90 days or less from the date of an abnormal Pap test. Risk ratios (RR) were calculated by building a generalized linear model fit using a Poisson distribution, log link, and robust variance.ResultsOverall, 177 of the 270 women (65.6%) received follow-up within an optimal diagnostic interval. After adjusting for other variables in the model, women who were 30 years of age or older were 32% more likely to have an optimal interval than younger women (adjusted RR = 1.32, P < 0.01). High school graduates were less likely than more educated women to have an optimal interval (adjusted RR = 0.68, P < 0.01). Participation in the NBCCEDP was not associated with receipt of follow-up within an optimal diagnostic interval.ConclusionsCompared with women with greater educational attainment, high school graduates were less likely to receive follow-up within an optimal diagnostic interval, as were younger (< 30 years) women compared with older women. Participation in the NBCCEDP was not associated with receipt of care within an optimal diagnostic interval.

Reducing Socioeconomic Disparities in Comprehensive Smoke-Free Rules among Households with Children: A Pilot Intervention Implemented through a National Cancer Program.

Most households with a smoker do not implement comprehensive smoke-free rules (smoke-free homes and cars), and secondhand smoke (SHS) exposure remains prevalent among children and low-socioeconomic status (SES) populations. This pilot project aimed to assess implementation feasibility and impact of an intervention designed to increase smoke-free rules among socioeconomically disadvantaged households with children. The pilot was implemented through Minnesota’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). NBCCEDPs provide cancer prevention services to low-income individuals experiencing health disparities. We successfully utilized and adapted the Smoke-Free Homes Program (SFHP) to address comprehensive smoke-free rules among households with children. We used two recruitment methods: (a) direct mail (DM) and (b) opportunistic referral (OR) by patient navigators in the NBCCEDP call center. We used descriptive statistics to assess implementation outcomes and hierarchical logistic regression models (HLM) to assess change in smoke-free rules and SHS exposure over the study period. There was no comparison group, and HLM was used to examine within-person change. A total of 64 participants were recruited. Results showed 83% of participants were recruited through DM. OR had a high recruitment rate, and DM recruited more participants with a low response rate but higher retention rate. Among recruited participants with data (n = 47), smoke-free home rules increased by 50.4 percentage points during the study period (p < 0.001). Among recruited participants who had a vehicle (n = 38), smoke-free car rules increased by 37.6 percentage points (p < 0.01) and comprehensive smoke-free rules rose 40.9 percentage points (p < 0.01). Home SHS exposure declined, and within-person increase in smoke-free home rules was significantly related to less home SHS exposure (p < 0.05). It is feasible to adapt and implement the evidence-based SFHP intervention through a national cancer program, but the current pilot demonstrated recruitment is a challenge. DM produced a low response rate and therefore OR is the recommended recruitment route. Despite low recruitment rates, we conclude that the SFHP can successfully increase comprehensive smoke-free rules and reduce SHS exposure among socioeconomically disadvantaged households with children recruited through a NBCCEDP.

Abstract B008: South Carolina's National Breast and Cervical Cancer Early Detection Program narrows the gap in South Carolina breast cancer disparities

Abstract Background: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides screening for breast cancer and, ultimately, navigation to treatment services for women who are economically disadvantaged and unable to afford such services. Consequently, SC's NBCCEDP, the Best Chance Network (BCN), is crucial in helping to address the excess burden of breast cancer mortality experienced by black women as well as those with lower socio-economic status. Purpose: The purpose of this investigation was to compare time to each treatment modality (surgery, chemotherapy, radiation therapy, and hormonal therapy) between BCN participants and participants in Medicaid or a private payor insurance plan. Methods: SC Central Cancer Registry data (2002-2010) were linked to administrative data from Medicaid or another private payor insurance plan. Eligibility criteria included white or black race and continuous enrollment in their respective insurance plan for 3 years post diagnosis. Time from diagnosis to date of first surgery, chemotherapy, radiation therapy, and hormonal therapy were calculated from administrative data files. T-tests and chi-square tests were used to compare descriptive statistics as appropriate. Cox proportional hazards models were used to assess the relationship among BCN participation, treatment times, and survival. Results: No significant differences were noted for time to surgery, chemotherapy, or hormonal therapy between BCN participants and the rest of the cohort. Interestingly, significant differences were noted between the two groups for time to radiation therapy (178 days for BCN vs. 150 days for the rest of the cohort, p=0.05). In multivariable Cox models, there were no breast cancer survival differences by BCN participation (p=0.94) after adjusting for age, stage, and insurance type. Among BCN participants, Cox models did not demonstrate any relationship between treatment time (for any treatment type) or race with survival after adjusting for age and stage. Conclusion: This work provides evidence that emphasizes the important role that state programs such as the BCN play in navigating women into timely treatment and eliminating the disparity that is often seen for the receipt of breast cancer treatment among economically disadvantaged women. Furthermore, this work highlights the potential for these programs to decrease mortality disparities experienced by black women in SC. Citation Format: Swann Arp Adams, Samantha C. Truman, Oluwole Babatunde, Tisha M. Felder, Jan M. Eberth, Sue P. Heiney, Christian R. Alvarado, James R. Hebert. South Carolina's National Breast and Cervical Cancer Early Detection Program narrows the gap in South Carolina breast cancer disparities [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 B008.