Abstract B70: Never screened: Understanding breast cancer nonadherence in Puerto Rico
Authors: Ayala-Marin Aleli M. , Colon-Lopez Vivian , Velez Camille , Fernandez-Espada Natalie , Fernandez Maria E. 
Published: May 2015

Abstract
Background: In Puerto Rico (PR), breast cancer was reported to be the leading cancer among women, accounting for approximately 31% of new cancer cases and 52% of cancer deaths. Mammography screening can reduce mortality approximately 20% by detecting breast cancer at early stages, for which less aggressive treatments and therapies are available. There is little published data regarding factors in PR that could explain mammography non-adherence and if those factors are different between previously screened and never screened women.
Objectives: To analyze factors associated with breast cancer screening non-adherence between never screened and previously screened, but not currently adherent women.
Methods: Cultivando La Salud is a breast and cervical cancer screening promotion program originally designed for low-income Hispanic women over 50 years old that was minimally adapted for Hispanic woman over 21 years old living in PR. The main objectives of Cultivando La Salud PR were to: (1) evaluate the effectiveness of Cultivando La Salud PR, an evidence-based educational intervention aimed to increase breast and cervical cancer screening tests; (2) increase breast and cervical cancer screening tests among women participants in the study; (3) increase the capacity of a community-based organization in the implementation and evaluation of evidence-based interventions in cancer prevention. Women were eligible to participate in Cultivando La Salud PR if they were non-adherent to breast cancer screening (women age 40 years or older that reported not having a mammography in the past year) or non-adherent to cervical cancer screening (women age 21 years or older that reported not having a Pap test in the last three years) and in good health. This program took place in Canóvanas, a municipality of PR, during the 2012-2013 year period. For purpose of this analysis, only data from not-adherent women to breast cancer screening guidelines (n=301) were used.
Statistical Analysis: Descriptive statistics were performed to characterize the study population. Bivariate analysis was used to assess breast cancer screening non-adherence (never screened vs. previously screened women) as the dependent variable and variables who achieved statistical significance (p &lt;0.05) in the bivariate analysis were then included in an age-adjusted logistic regression model. Age-adjusted Prevalence Odds Ratio (POR) with their 95% confidence intervals were also calculated.
Results: Data from the baseline survey indicated that 22.0% of the participants older than 40 years old never had a mammography. Never screened women were 4 times more likely to report having Mi Salud, a governmental healthcare plan (age-adjusted POR=4.1, 95%CI:1.3-7.5) and were 3 times more likely to have a family income of less than $15,000 than women previously screened but not adherent (age-adjusted POR=3.1, 95%CI:1.3-7.5). Never screened women were also approximately 3 times more likely to report not having an usual place for receiving routine health care (age-adjusted POR=2.9, 95%CI:1.5-5.3) and were 2 times more likely to have not have a Pap test in the last three years (age-adjusted POR=2.3, 95%CI:1.2-4.3).
Discussion: Never screened women reported significant socioeconomic disparities that might be affecting mammography screening practices. A better understanding of the barriers that prevent breast cancer screening in this group will help in the design of educational interventions and public health policies targeted to increase mammography rates in PR.
Citation Format: Aleli M. Ayala-Marin, Vivian Colon-Lopez, Camille Velez, Natalie Fernandez-Espada, Maria E. Fernandez. Never screened: Understanding breast cancer nonadherence in Puerto Rico. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B70. doi:10.1158/1538-7755.DISP13-B70