Increasing Mammography Screening Among Native Women
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: Breast cancer in past generations was reported to be very rare among American Indian/Alaska Native (AI/AN) women, but incidence and mortality rates have been increasing in the past 20 years, and are projected to continue to increase. Breast cancer is now the second leading cause of cancer death among AI/AN women. Breast cancer deaths could be reduced by more than 30% in AI/AN women if current recommendations for screening were followed. AI/ANs have had the poorest cancer screening rates of any ethnic group (42% of AI/AN women 50 years of age and older were screened in California in 2007), and those with breast cancer have had the lowest 5-year survival rate when compared to other ethnic groups. Older AI/AN women (65 and over) are even less likely to be screened for breast cancer.
 
 
 
 
 
 
 
 The goal of this study is to address this unequal burden of breast cancer among AI/AN women by using the results from the successful CBCRP-funded 18-month pilot project to deliver the Mother’s Wisdom Breast Health Program in a randomized behavioral clinical trial to 1,250 AI/AN women in California and to increase breast cancer screening rates from 42% to the Indian Health target of 70% or higher. The Program uses a cultural framework design to increase knowledge about breast health and to eliminate cultural barriers to mammogram screening, resulting in increased mammography screening among AI/AN women in California.
 
 
 
 
 
 
 
 The research questions we are seeking to answer with this full study are: 
 
 
 
 1) Are AI/AN women more knowledgeable about breast cancer following the Mother’s Wisdom Breast Health intervention; and 
 
 2) do AI/AN women report more positive attitudes and beliefs about breast cancer screening following the intervention.
 
 
 
 
 
 
 
 One urban and four rural Indian health clinic partners will recruit and enroll a total of 1,250 AI/AN women into the Mother’s Wisdom Breast Health Program. Each enrolled woman will complete a baseline survey to assess knowledge and attitudes related to breast cancer and then the women will be randomly assigned to either a Mother’s Wisdom intervention group or the Usual Care group. A wait-listed design will ensure that each participant will receive the intervention, but at different times. Women in the intervention group will attend Talking Circles, which are groups of 10-15 women, where they will view and discuss the Mother’s Wisdom Breast Health Program DVD. All women will complete a follow-up assessment of knowledge and attitudes within 60 days of enrollment. Clinic Community Health Workers will be trained in the Mothers’ Wisdom Breast Health Program and in community-based participatory research; and will monitor all clinic participants to determine if they schedule and complete mammograms during the three-year study. Clinic mammography screening information on the participants will be submitted to the co-PIs monthly. Final study results will be shared with the clinics and tribal communities for analyses and interpretation; dissemination of the results will include presentations to tribal health gatherings, Pow-Wows, tribal council meetings and AI/AN community events as well as at medical and professional meetings, in lay and scientific publications and in a book on CBPR with AI/AN communities.
 
 
 
 
 
 
 
 Because so little is known about how to increase mammography screening and reduce mortality rates from breast cancer in Indian Country, this study has high translational potential if successful. This is also one of the few breast cancer risk reduction programs to use high level culturally sensitive recruitment strategies, multi-sensory educational tools, and community engagement research methods in AI communities.
 
 
 
 
 
 
 
 An American Indian Advisory Council of 12 members from 11 tribes will guide the project and oversee the testing and evaluation of the Mother’s Wisdom Breast Health Program through urban and tribal health clinic partner research sites. The clinics serve about 25 different tribes in both urban and remote rural areas. The community co-PI, the Council and the partner clinics will be involved throughout the research process.
 
 
 
 
 
 
 
 After the successful completion of this full study, the next goal will be to widely disseminate the Mother’s Wisdom Breast Health Program throughout California as well as nationally. The Program will be made available to AI/AN urban and tribal health clinics throughout California and the rest of the country. This study will include training in CBPR and the Mother’s Wisdom Breast Health Program to Community Health Workers and tribal leaders to ensure sustainability after funding ends.