Abstract A34: Using a community-based breast health intervention to reduce structural barriers in accessing breast cancer screening services among underserved rural Latina and black women in Eastern North Carolina
Authors: Torres Essie T. , Richman Alice R. 
Published: May 2016

Abstract
Background: Although breast cancer mortality rates have been steadily decreasing over time, Black and Latina women continue to have the highest death rate and shortest survival of any racial and ethnic groups in the United States for breast cancers. Most scholars agree, however, that the major cause of this disparity is more likely to be diagnosed with late (vs. early) stage breast cancers that are less responsive to treatment. This disparity in cancer-stage-at-diagnosis reflects Black and Latina women's lower prevalence of breast cancer screening that could detect cancers at earlier, curable stages. Pitt and Edgecombe Counties, located in a rural disadvantaged part of Eastern North Carolina (ENC), maintain breast cancer disparities among its minority women as compared to their white counterparts. Breast cancer incidence among minority women is lower compared to white women for both counties, however the mortality rate for minority women is twice as high compared to their white counterparts (42.4 vs. 21.9 respectively) in Pitt county and slightly higher in Edgecombe county (37.3 vs. 36.7 respectively). Pitt County also has the highest breast cancer mortality rate among minority women and Edgecombe has the fifth highest in Eastern NC. Furthermore, minority women are diagnosed at later stages of the disease, with the rate of diagnosis at stage 4 being almost three times higher than white women in Pitt County and significantly higher in Edgecombe County. This community-based breast health intervention (The Pitt County Breast Wellness Initiative-Education) works to reduce these health disparities in breast cancer mortality through provision of education and navigation to early detection and access to screening for uninsured and underinsured Black and Latina women in Edgecombe and Pitt Counties in NC.
Methods: The Pitt County Breast Wellness Initiative-Education provides culturally tailored breast cancer education and navigation to age-appropriate screening services for uninsured/underinsured Black and Latina women age 25 and older in Pitt and Edgecombe Counties, North Carolina. Using a lay health model (adapted from North Carolina Breast Cancer Screening Program Training Curriculum), we trained eight community members on breast health, breast cancer, and being an effective breast health educator. The education component includes a brief 10-minute presentation on breast health, breast cancer, and guidelines for age-appropriate breast cancer screening services. The navigation component includes assistance with the following: (1) Breast Health Assessment Tool and BCCCP applications, (2) scheduling appointments/accessing age-appropriate breast screening services, (3) interpretation, and (4) transportation. Since our program initiation in April 2015, we have educated 85 women and navigated 47 to age-appropriate breast cancer screening services in Pitt and Edgecombe counties.
Results: Among the 47 navigated women to age-appropriate screening, 78% (n=37) were 40 years of age or older, 82% (n=39) reported being uninsured, 32% (n=15) reported no previous clinical breast exam, and 38% (n=18) reported no previous mammogram. Among those who reported a having a previous mammogram, many were 2 years or more over due for their yearly mammogram. We use pre-/post-surveys to determine an increase in knowledge and awareness regarding breast health, breast cancer, and guidelines for age-appropriate breast cancer screening services. Up-to-date results from program participants will be reported during the presentation.
Conclusion: Specifically, using a LHA community-based model allows this program to serve as a cultural mediation between underserved communities in Pitt and Edgecombe counties and health care service systems and reduces structural barriers in accessing screening services and diagnostic follow-up. Strong collaborative community partnerships will streamline the process of accessing care in an effort to ensure seamless transition within the continuum of breast cancer care.
Citation Format: Essie T. Torres, Alice R. Richman. Using a community-based breast health intervention to reduce structural barriers in accessing breast cancer screening services among underserved rural Latina and black women in Eastern North Carolina. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A34.