Advancing Breast Health among Uninsured Women in Central Texas: A Collaborative Effort to Increase Breast Cancer Screening via Mobile Mammography
Introduction
Breast cancer is the most diagnosed cancer among women in Texas and the second leading cause of cancer deaths. Uninsured, underinsured, and rural women residing in Texas have low screening rates compared to women of the same demographics in other states, and breast cancer is the leading cause of cancer among rural women. Breast cancer incidence is also high among women residing in Central Texas compared to the rest of the state. Mobile mammography helps to address access issues to breast cancer screening resulting in increased service delivery among rural, geographically remote, un- and under-insured women. We will be describing the Advancing Breast Health Among Uninsured Women in Central Texas program components and results to date.
Methods
The Advancing Breast Health among Uninsured Women program is a CPRIT-funded intervention and collaborative effort between Dell Medical School (DMS), Lone Star Circle of Care (LSCC), a Central Texas-based Federally Qualified Health Center, and Addressing Cancer Together (ACT) Coalition that provides outreach, education, mobile mammography, and navigation services to un- and under-insured women aged 50 to 75 from Bastrop, Caldwell, and Travis counties. Evaluation is being conducted on an ongoing basis through participant experience surveys and interviews.
Results
The mobile mammography services were successfully initiated and have been ongoing since July 2021. As of July 2023, a total of over 300 events at 45 different locations have been held and 3,704 screenings have been completed. Five hundred women have been navigated to diagnostic services and 12 women have been diagnosed with cancer and successfully navigated into treatment. Of the 3,704 screenings: 65% of women were Hispanic, 52% were at or above the age of 50, 53% reported Spanish as their preferred language, 91% were at or below the 250% Federal Poverty Level, and 90% of all screenings were provided to women who did not have commercial insurance coverage. Five hundred seventy-eight patient surveys have been completed and most commonly identified perceived barriers for mammogram completion included: cost (45.1%) and embarrassment (25.7%), followed by no transportation (8.4%), inability to take time off work (8.4%), and taking too much time (5.2%). 52.2% of women report a preference for mobile mammography services compared to a fixed site location. Emerging themes from interviews reveal: 1) low- to no-cost services and easy access to a convenient location as women’s primary reasons for receiving a mammogram on the Bus; 2) women’s positive experiences with services were centered around little to no wait time, privacy, and staff creating a hospitable and comfortable environment; 3) a need to better communicate and advertise the Bus and its services via community events, organizations, and clinics; and 4) a need to integrate the BPB more among low-income communities.
Conclusion
Mobile mammography can address commonly identified barriers to screening among underserved and diverse populations and meets a large need in the community. Improvements to outreach, community engagement and presence may help to increase reach and breast cancer screening completion rates.