Abstract P1-17-03: Impact of a culturally syntonic door-to-door breast cancer early detection intervention
Authors: Calfa Carmen J , Wilkinson Julie G , Williams Mindy M , Pann James M , Yehl Angela , Hoogenbergen Stephanie E , Ivory Andrea D 
Published: May 2015

Abstract
Introduction. Disparities in the detection of breast cancer persist despite efforts to reach underserved populations and increase mammography utilization. Black and Hispanic women are more likely to be diagnosed at a later stage compared to White women. Lack of health insurance and limited awareness of breast cancer are significant predictors of screening behaviors; other reasons remain poorly understood and warrant further research. Our study presents highlights of the Women’s Breast Health Initiative Florida Affiliate (WBHI) intervention and key findings related to its impact.
Methods. The intervention targeted single-family home neighborhoods with high incidence of late-stage breast cancer, median income at 200% of the poverty level, and access to affordable health clinics. Neighborhood mobile mammography or transportation to local facilities was provided, followed by navigation to assure proper follow up. Eligible women were uninsured, ≥40 years of age and were qualified for an annual screening mammogram.
During 2011-2012Intervention Days45Educational Materials21,079Volunteers*2,025Women Interviewed5,441Eligible Women643Appointments Scheduled581Screening Days15Screening Mammograms Completed409*culturally relevant & trained
Descriptive and inferential statistical methods were used to analyze participant data divided into 3 groups based on neighborhood racial demographics: "Black" or "Hispanic" data groups had ≥75% Black or Hispanic residents respectively, while the "Other" did not have a predominant race. Post-visit phone surveys of 1,871 participants were conducted within 30 days.
Results. The intervention significantly increased screening rates amongst eligible women from 22% to 64%, had a 0.24% breast cancer diagnosis rate and motivated 59% of the women to propagate awareness. Health insurance coverage rates did not differ significantly between the 3 groups. Notably, amongst the insured, those from "Hispanic" neighborhoods had the highest recent mammogram rate while, amongst the uninsured, those from "Black" neighborhoods had the highest. Neighborhood culture and prior mammogram history impacted the efficacy of the intervention. Among the "Hispanic" and "Other" groups, women with no prior mammograms were less receptive to receiving one compared to those who had prior mammograms. This phenomenon was not observed in the "Black" group. Women’s responses and perceived benefit to the educational package differed according to the neighborhood race and ethnicity:
"Black""Hispanic""Other"Benefited70%85%88%Spread the Word54%57%65%
Discussion. WBHI reached the goal of increasing screening rates in this underserved population, thus showing that this type of intervention can be effective. Educational packages presented in a face-to-face format within a door-to-door context were found useful by most women. Our findings highlight disparities beyond a woman’s access to breast healthcare and education by showing that neighborhood culture impacts response to outreach intervention and breast healthcare. This generates the hypothesis that given equal access to care, disparities in using screening mammography will remain. Educational methods further tailored to racial and ethnic characteristics may play a significant role in closing disparity gaps.
Citation Format: Carmen J Calfa, Julie G Wilkinson, Mindy M Williams, James M Pann, Angela Yehl, Stephanie E Hoogenbergen, Andrea D Ivory. Impact of a culturally syntonic door-to-door breast cancer early detection intervention [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-17-03.