Abstract C73: A mobile mammography outreach program to increase screening in medically underserved areas in Missouri
Authors: Komaie Goldie , Lyons Sarah , Appleton Catherine , Glover-Collins Katherine , Marx Christine , Colditz Graham 
Published: February 2019

Abstract
Background: Breast cancer screening rates still lag behind US Preventive Services Task Force recommendations. Mobile health units are one common strategy to address barriers to mammography screening. Mobile mammography programs improve screening rates in medically underserved and rural communities by reducing barriers such as cost and travel distance. The aim of this study was to evaluate the characteristics of women who participated in a mobile mammography screening program affiliated with a comprehensive cancer center in Missouri.
Methods: The Alvin J. Siteman Cancer Center (SCC) at Washington University School of Medicine initiated a Mammography Outreach Registry to assess the effectiveness of mammography services among the medically underserved. The Breast Health Center is housed within the SCC and provides on-site service as well as off-site care through use of a single mobile mammography van (MMV). The Registry database included women who received a mammogram on the MMV between April 2006 and July 2015. The total sample included 10,523 women. The sample was stratified to examine women served by the MMV who lived in designated Medically Underserved Areas (MUAs) versus non-MUAs.
Results: The MMV traveled throughout much of the eastern portion of Missouri, serving both the urban St. Louis region as well as rural areas in the southeastern “Bootheel” region. The total sample included 57% non-Hispanic Black, 33% non-Hispanic White, and 10% of other races, with a mean age of 52 years old. The majority (72%) of women had no insurance and were unemployed (67%). Over three-quarters (77%) reported annual household income less than $20,000 and 74% had completed 12 years or less of education. About one-quarter of women reported a family history of breast cancer and presented for their first mammogram (21%). Approximately 25% of women who received MMV services were from MUAs, mainly in St. Louis City, northern St. Louis County, and the rural Bootheel region. MUAs had a statistically significantly higher prevalence of women who are Black, unmarried, have lower education and lower income, and who are current cigarette smokers compared to non–MUAs.
Conclusions: The MMV improved access to breast cancer screening among a largely vulnerable uninsured population, reaching women in both urban and rural areas in Missouri. In particular, the MMV successfully engaged economically disadvantaged women in MUAs including women without health insurance, who had never had a mammogram, and those with a family history of breast cancer. While much of the research on MMVs illustrates the impact on improving access to mammography in rural areas, this study highlights there is an unmet need for low/no-cost preventive services in both urban and rural areas. In states such as Missouri, with a large number of health professional shortage areas and that did not expand Medicaid under the Affordable Care Act, MMVs are even more imperative to provide mammography screening to populations that do not routinely access preventive health services. MMVs should work closely with community-based partners and safety net health clinics in both urban and rural MUAs to maximize MMVs outreach efforts. Further, given the higher number of women in MUAs reported as current smokers, outreach conducted by MMV staff may also coordinate efforts to create interventions tailored to women who smoke in MUAs to address smoking cessation.
Citation Format: Goldie Komaie, Sarah Lyons, Catherine Appleton, Katherine Glover-Collins, Christine Marx, Graham Colditz. A mobile mammography outreach program to increase screening in medically underserved areas in Missouri [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C73.