Abstract P6-11-13: Identification of barriers to breast cancer screening that affect compliance
Authors: Allison Huff MacPherson, Jorge Gomez, Elizabeth Calhoun, Marisa Borders, Kimberly Fitzpatrick, Yessenia Prado, Dora Bezies-Lopez, Chiu-Hsieh Hsu
Journal: Cancer Research (2020)

Abstract Background: In 2015, the latest year for which the Center for Disease Control (CDC) has incidence data, 242,476 new cases of Female Breast Cancer were reported, and 41,523 women died of Female Breast Cancer in the United States. For every 100,000 women, 125 new Female Breast Cancer cases were reported and 20 died of cancer. In Arizona, breast was the leading site of new cancers in 2015, with 110.9 new breast cancer diagnoses per 100,000 women, and is second for cancer deaths, reporting 19 deaths per 100,000 women. This study specifically addresses low screening rates among women in Pima County in Southern Arizona through a telephone navigation program with the goal of increasing follow-up mammograms and recommended breast imaging. Our short-term goal is to increase both initial screening and diagnostic resolution rates among women in Southern Arizona. Our long-term plan is to develop a sustainable model to increase breast cancer screening among women that is expected to inform programs state-wide and nationally. Specific aims are: 1) to increase adherence or repeat screening rate by 20% for women lost to follow-up; 2) Establish the framework for a community-academic partnership that can be replicated in other Hispanic-based areas. Methods: Potential study participants were identified using Electronic Health Records and categorized by Breast Imaging-Reporting and Data System (BI-RADS) 0 to 5. Inclusion criteria include non-compliant women of any race/ethnicity between the ages of 40 and 75 who have been referred to, or seen at a breast imaging clinic in Tucson, Arizona (Pima County) from January 1, 2014 to September 30, 2017. Of those non-compliant, 47% had a BI-RADS 0,3,4, or 5. With IRB approval from University of Arizona, we adapted a questionnaire validated for use in colon cancer to measure screening knowledge, motivations and barriers to adherence, and self-efficacy. Two navigators reached out to participants to recruit and re-engage them in the care process. Results: The sample is n=9661 of noncompliant patients from a clinic in Southern Arizona, 26% were Hispanic and 65% non-Hispanic, with 10% with 9% requiring an interpreter. From this sample, 123 study participants have been recruited (300 target accrual) with a 21% recruitment rate, 46% unable to reach rate, and a 47% decline rate. Notably, of those who declined, 66% reported being compliant at another clinic. The participants were 46% non-Hispanic and 52% Hispanic, with 25% requiring an English/Spanish interpreter. Nearly half had less than or a high school degree and similarly, nearly half had a monthly family income of $2000 or less. On the questionnaire section of knowledge, there were no statistically significant results indicating extensive knowledge, except for how often one should have a mammogram, in which 93% answered correctly. On the Barriers to Getting a Mammogram section, when the data was disaggregated by ethnicity, there was statistically significant (P⇒.05) responses. One barrier identified was financial reasons (P=.05), but interestingly no (0) Hispanics reported financial reasons to be a barrier. Conclusion: The high number of declined due to compliant elsewhere points to the need to develop a business case to sustain lay navigators across the breast cancer continuum, from screening to diagnostic resolution, treatment, survivorship, and/or palliative care. Further, breast cancer and breast screening education materials will be developed in the next phase of this study and interventions to address financial reasons. For more information on this study, please contact Drs. Jorge Gomez (Jorgejgomez@email.arizona.edu), Allison Huff MacPherson (allison7@email.arizona.edu). Citation Format: Allison Huff MacPherson, Jorge Gomez, Elizabeth Calhoun, Marisa Borders, Kimberly Fitzpatrick, Yessenia Prado, Dora Bezies-Lopez, Chiu-Hsieh Hsu. Identification of barriers to breast cancer screening that affect compliance [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-13.