Abstract B89: Understanding changes in the USPSTF mammography screening guidelines: The role of the Avon Breast Health Outreach Program in reaching underserved women.
Authors: Bluethmann Shirley M. , Allen Jennifer D. , Mills Hannah L. , Opdyke Kelly Morrison , Gates-Ferris Kathryn , Hurlbert Marc , Harden Elizabeth 
Published: August 2014

Objective: Given recent changes to mammography screening guidelines from the US Preventive Services Task Force (USPSTF) advising against routine screening of women ages 40-49, we sought to better understand knowledge, attitudes and educational practices of those charged with educating women about breast cancer screening. A major goal of the Avon Breast Health Outreach Program (BHOP) is to educate women about breast cancer early detection and to connect them to screening services. Special emphasis is focused on reaching women in underserved communities where there are disproportionately high rates of advanced-stage disease and breast cancer mortality. BHOP supports breast health Outreach Educators (OE), Case Managers (CM) and Patient Navigators (PN) who assist women from the point of learning about screening, getting screened and following up on results, as needed. The revised USPSTF guidelines have caused controversy and confusion among the lay public, as well as breast health educators and providers.

Methods: An online survey of Avon BHOP fiscal year 2011 grantees was conducted to document understanding of USPSTF guideline changes, strategies used to educate BHOP clients and provide decision support, and to identify potential training needs. An electronic mail invitation was sent to a total of 175 Avon BHOP grantee organizations across the US (n=112 community-based organizations and 63 Safety Net Hospitals). Avon BHOP OEs, CM, and PN participated in the self-administered, anonymous survey between December 2011 and January 2012.

Results: A total of 164 respondents completed survey. Most were over age 40, had at least a college education, and reported that their role was to reach underserved, underinsured, and uninsured women. Half were White (49%) and about a quarter were Hispanic or African American (25% and 23%, respectively). Despite the USPSTF guideline change, 86% of respondents reported that they continue to tell women ages 40-49 that they should have an annual mammogram. The majority (75%) learned about the guideline change through mass media. Of those who were aware of the guideline change, 73% reported that they did not agree with the change; most did not believe that there were disadvantages to having a mammogram. Few respondents perceived the need to discuss the pros and cons of screening with their clients.

Conclusions: In our sample of relatively well-educated BHOP staff, knowledge and awareness regarding USPSTF guidelines for mammography was low. Our findings support the notion that stakeholders, including women, breast cancer educators and outreach workers, remain committed to annual mammography for women over 40. Results indicate a need for additional training for BHOP staff regarding the range of mammography screening guidelines across major medical organizations, and strategies for explaining inconsistencies to their clients. While the need for decision support for women age 40-49 was not recognized as a high priority, helping women to understand that there are pros and cons of screening in this age range are also needed for informed decision-making, especially in underserved communities.

Citation Format: Shirley M. Bluethmann, Jennifer D. Allen, Hannah L. Mills, Kelly Morrison Opdyke, Kathryn Gates-Ferris, Marc Hurlbert, Elizabeth Harden. Understanding changes in the USPSTF mammography screening guidelines: The role of the Avon Breast Health Outreach Program in reaching underserved women. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B89.