Abstract A030: Empowering Latinas to obtain breast cancer screenings: Comparing intervention effects and cost effectiveness
Authors: Molina Yamile , San Miguel Liliana G. , Pichardo Catherine , Rios Genesis , Diaz Leslie , Cardenas Stephanie , Cardoso-Mendoza Esmeralda , Arroyo Juanita , Medina Maria , Coronado Nora , Lucio Araceli , Hernandez Olivia , Walton Surrey 
Published: August 2020

Purpose: Latinas suffer disproportionately from breast cancer relative to non-Latina Whites, partially due to lower guideline-concordant screening. Multiple approaches are used to address this disparity including educational interventions and empowerment-related interventions, wherein a subset of the population is trained to share information with other members of the priority population. However, little is known about the relative effects of these different approaches.

Objective: To analyze preliminary data regarding the effectiveness and cost-effectiveness of education and empowerment approaches.

Methods: This ongoing, quasiexperimental trial is situated in two lower-income Latino communities in Chicago. Eligibility criteria include: 1) age of 52-74; 2) no mammography use within past 2 years; 3) no previous breast cancer diagnosis; and 4) no prior health volunteerism experience. Women are assigned to a cohort and participate in a three-week intervention (education: breast cancer, diet, physical activity; empowerment: breast cancer, sharing information with networks, health volunteerism). For women who wish to obtain mammography (from either arm), the study team provides navigation to free/low-cost services. Data collected at baseline, post-intervention, and six-month follow-up include standard demographics and self-reported mammography use, which are verified by study navigation records. The perspective for cost-effectiveness analyses was the community-based organization implementing the program. Cost data include overhead, non-personnel, and personnel costs (per task, per person encounter). Cost data were standardized to US dollars in 2018 and extrapolated to the duration of study implementation.

Results: Our current sample is 97 women (51 education; 46 empowerment). Most women were 52-64 years old (70%), had insurance (58%), had less than a 9th grade education (60%), had an annual household income of &lt;$15,000 (67%), and were born in Mexico (86%). More empowerment participants obtained a mammogram than education participants, after adjusting for age, education, income, insurance, mammography history, and mammography plans (47% vs. 74%; OR = 3.2, 95%CI [1.1, 9.00], p=.001). The empowerment intervention was also less expensive. The costs for education and empowerment interventions were $32,919 and $24,983 ($645 and $490 per person), respectively. Hence, empowerment appears to be a dominant strategy.

Discussion: Empowerment approaches may be more effective and more cost effective in promoting mammography than education approaches among non-adherent Latinas. Limitations concern generalizability due a non-probability based sample, and limited ability for causal inferences due to a lack of randomization. Next steps include incorporating participants' costs and including unintended effects (e.g., number of non-participant women obtaining mammography).

Citation Format: Yamile Molina, Liliana G. San Miguel, Catherine Pichardo, Genesis Rios, Leslie Diaz, Stephanie Cardenas, Esmeralda Cardoso-Mendoza, Juanita Arroyo, Maria Medina, Nora Coronado, Araceli Lucio, Olivia Hernandez, Surrey Walton. Empowering Latinas to obtain breast cancer screenings: Comparing intervention effects and cost effectiveness [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 A030.