Abstract SS01-05: Multilevel breast cancer intervention in Latinas.
Authors: Thompson Beti , Beresford Shirley AA , Coronado Gloria D. , Argula Antoinette , Bishop Sonia , Duggan Catherine C. 
Published: August 2014

Abstract
Introduction: Hispanics are the fastest growing population in the United States (US). They present a mixed picture of cancer incidence and mortality. For breast cancer, Latinas have a lower incidence (83.5 per 100,000) than non-Hispanic White (NHW) women (147.3 per 100,000); however, with longer time in the US, breast cancer incidence increases in Latinas. Further, they are more likely to be diagnosed in late stage and therefore have lower five year survival rates than NHW women. Finally, Latinas are more likely to suffer from triple negative cancers that are more aggressive than estrogen-receptive cancer. One reason for the late-stage diagnosis may be that Latinas, especially Mexican-American women, are less likely to present for mammography screening than NHW women. In a recent study by Miranda et al., evidence shows that for Mexican-American women overall, less than 60 percent have had a mammogram. Furthermore, the lack of a medical home means that many Latinas do not routinely receive messages about the importance of mammography nor are they likely to receive referrals for mammography. In our P-50 funded by the National Cancer Institute's Center for Population Health and Health Disparities (CPHHD), we have a multi-level mammography promotion project. Called Fortaleza Latina, the overall goal of the project is to develop and test a culturally-appropriate multi-level intervention aimed at increasing screening mammography utilization in a clinic-based sample of Latino women in Western Washington State. Of corollary interest is the way Latinas perceive their risk of getting breast cancer and their response to perceived risk. For this study, we are especially interested in perceptions of risk and decisions Latinas report they would make based on their perceptions.
Methods: In a two-armed study (control vs. intervention), Latinas who are out of compliance with mammography are identified by a federally qualified health clinic system. After a baseline survey is conducted, women are randomized to receive the intervention vs. usual care. The baseline survey contains a number of questions that are related to breast cancer risk perception by Latinas. Three questions that assess perceived risk refer to one's own risk of developing breast cancer, one's risk compared to other women, and one's worry about developing breast cancer. Variables that were examined as correlates of risk include the presence of a medical home, the presence of health insurance, the financial ability to pay, attitudes about recommendations for mammography, and demographic variables.
Results: Of 358 women who were out of compliance with mammography and who responded to the baseline questionnaire to date, 94 percent were of Hispanic origin. Of these, 91 percent speak Spanish most of the time and 97 percent were born outside of the US with over 80 percent born in Mexico. In terms of perceived risk of developing breast cancer, 41 percent perceived their risk as low, 41 percent as moderate, and 18 percent as high. Perceived risk compared to others was more likely (10%), about the same (57%), and less likely (33%). In terms of worry, 31 percent said rarely, 51 percent said sometimes, and 17 percent said frequently. There were no relationships between medical home and perceived risk or health insurance and perceived risk, although over 53 percent of respondents said cost would be an issue.
Discussion: Perceived risk of breast cancer in this population is relatively low, with 1 in 5 women perceiving their risk as high. Many variables that were thought to correlate with risk did not do so, suggesting that commonly thought variables of association were not supported. Although this was a multi-level study looking at neighborhood, clinic, and individual, variation in the population was small with 49 percent of respondents having a household income of $15,000, 44 percent having $15,000 to $40,000, and only 6.7 percent having a total household income of more than $40,000. Conversely, it may be that the questions we asked about perceived risk and correlates of risk were not applicable to this group whose worries might be focused on more basic needs than risk of breast cancer. More study is needed to explore possible relationships in breast cancer risk among Latinas.
Citation Format: Beti Thompson, Shirley AA Beresford, Gloria D. Coronado, Antoinette Argula, Sonia Bishop, Catherine C. Duggan. Multilevel breast cancer intervention in Latinas. [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 SS01-05.