Advancing breast cancer care for underserved women: A study of the Pink Ribbon Mammogram Program in Oakland County.
Authors: Aldecoa Kim Abbegail Tan , Vojjala Nikhil , Ayoobkhan Fathima Shehnaz , Briefs-Ferris Andrea , Orejuela Jennifer , Fernandez Annelise , Mohammad Jani Asad , Dietz Grey , Tsukan Myroslava , Clark Ryan , Golston Victoria , Fitts Ashley , Mamon Brendan , Wani Danyal , Imoh Pearl , Cooper Oluwatosin , Jones Jasmine , Arsene Camelia , Kirby Amy , Goodman Judie R. 
Published: June 2024

11053

Background: The Pink Ribbon Mammogram program, a non-profit initiative in Oakland County, Michigan, aims to provide free breast cancer screening (BCS) to underserved and uninsured women, in partnership with Trinity Health Oakland. The program has served approximately 1500 women since 2009. This study aims to highlight the program’s effectiveness in providing free BCS and gather participant feedback to address challenges and improve its operational efficiency. The study also aims to evaluate the factors associated with participants' perceptions of BCS using the Revised Champion’s Health Belief Model scale (RCHBMS) and open-ended questions. Methods: A survey with open- and close-ended items was conducted among 253 women who participated in the program from 2019-2023 via structured telephone interviews. The RCHBMS, a validated tool, was used to measure participants’ perceptions of breast cancer susceptibility and screening benefits and barriers using a 5-point Likert scale (1=strongly disagree, 5=strongly agree). SPSS 28 was used for analysis, with a p-value<0.05 indicating statistical significance. Results: Over the last 5 years, the program has conducted 363 mammograms, 59 ultrasounds, and 2 biopsies, leading to 1 confirmed and treated case of breast cancer. Among 253 individuals with valid contact details, 96 consented to participate in the survey. Participant demographics are as follows: mean age 50 years; 80% Hispanic, 15% White, 5% Black; 76% primarily Spanish-speaking; all are uninsured or with high copay. The main reasons for participating included the benefit of free coverage (32.3%) and reassurance of being breast cancer-free (31.3%). 44% reported no issues in attending their appointments, while 8.4% faced logistical challenges, equally divided between work commitments and transportation issues, which were the main causes for missed appointments. The primary motivation for 81.3% of participants undergoing mammogram screening was early breast cancer detection. Using RCHBMS, the study also revealed a correlation between participants’ perceived susceptibility for breast cancer and their attitudes toward mammogram screening. Those who felt more susceptible to breast cancer also perceived greater barriers and lesser benefits to screening (p<0.05). Factors such as younger age, disability, and having private insurance with high copay were associated with increased perceived susceptibility to breast cancer (p<0.05). Conclusions: This study serves as an important evaluation of a community-driven BCS initiative, highlighting its successes and areas for improvement to better serve underserved populations. This program can serve as a model to increase BCS nationwide. Insights into factors influencing screening perceptions among underserved women offer valuable guidance for healthcare providers and policymakers to improve screening outcomes in similar communities.