Multi-faceted program to advance breast cancer health equity
Introduction
Breast cancer is the most common cancer in women in the U.S. and the second leading cause of cancer-related deaths both in the United States and in Texas. According to the National Cancer Institute (NCI), cancer disparities are often found in incidence, prevalence, mortality, survivorship, burden of cancer, stage at diagnosis, and screening rates. African American (AA) women, as well as Hispanics, particularly those from lower socioeconomic status, have been shown to have worse breast cancer treatment outcomes than white women. These worse outcomes are associated with advanced disease at diagnosis which could be prevented in many cases by regular screening mammograms. Health insurance (or lack thereof) is a primary reason for these differences. Additional contributing factors to these disparities relate to access to care and lack of education on breast cancer as a preventable and/or treatable disease. Additionally, COVID-19 pandemic led to a substantial decrease in cancer screenings. As one of the largest historically black colleges/universities (HBCU), Texas Southern University Breast Cancer Screening and Prevention Center (TSU BCSPC) was established to offer breast cancer screening/diagnostic services, patient navigation/barrier reduction services, and evidence-based literacy level appropriate breast cancer awareness and education for uninsured/underinsured AA women living in the medically underserved areas. In this study, we report the impact of TSU BCSPC in advancing breast cancer health equity among ethnic minority women.
Methods
This is a retrospective, descriptive analysis of survey completion and services offered by TSU BCSPC between March 2022 and May 2023. This study was approved by TSU Institutional Review Board. Eligibility criteria to receive no-cost mammogram or patient navigation services were uninsured or underinsured, from a medically underserved population, from a racial, ethnic, or cultural minority population, and >40 years (or < 40 years if at high risk for developing breast cancer). Education services were available to the general population. Descriptive statistics were used to analyze data on total number of services provided by type, age distribution of women that received mammogram, screening mammogram result by age range, screening mammogram request after an education session, no-show/cancellation rate for mobile screening mammogram, and response to some post-service survey questions.
Results
During the 15 months data analysis timeframe, 452 (41 insured, 402 uninsured, and 9 underinsured) women received a screening mammogram while 99 women received a diagnostic mammogram. We provided 2,980 patient navigation services and provided breast cancer awareness education to 2,271 individuals. Among the 586 women that we scheduled for mobile screening mammogram, 70% had their screening mammogram. Fifty percent of the women that received screening mammogram were between 40-49 years, 43% of the women were between 50 -64 years, 6% were 65 and older, while 1% were younger than 39. Among the 228 women between 40 and 49 years, 85 had negative mammogram results, 91 had benign findings on mammogram report, while 42 women needed additional imaging. Among the 195 women between 50 and 64 years, 75 had negative mammogram results, 83 had benign findings on mammogram report, while 32 women needed additional imaging. Ninety-six percent of the 207 women that completed post education survey requested screening mammogram while 73% acknowledged the importance of a healthy lifestyle.
Conclusion
TSU BCSPC as a multi-faceted program is uniquely positioned to fulfill an unmet need to provide breast cancer screening/diagnostic services, patient navigation/barrier reduction services, and evidence-based literacy level appropriate breast cancer awareness and education for uninsured/underinsured AA women living in the medically underserved areas. The data over these 15 months’ timeframe is evidence to our capacity to continue advancing breast cancer health equity.