Take care of your neighborhood



Urban women in certain Washington, DC neighborhoods present with advanced breast cancer at high rates despite access to health insurance and health care.


Through a two-phase intervention, community health workers (CHWs) educated and surveyed individuals regarding healthcare utilization and breast health and cancer awareness. In phase I, CHWs educated and administered a survey to 1092 women, of whom 95.1% had health insurance, in an attempt to explain the high rate of advanced breast cancer despite having health insurance. In phase II, a targeted CHW-administered intervention was designed based on data collected from the phase I survey, and provided to 658 women. Preintervention and postintervention surveys were administered to assess its impact on knowledge and beliefs about breast health and cancer screening.


During phase I, respondents most often identified personal factors (28.7%) and fear (27.7%) to explain the high rate of advanced breast cancer despite health insurance status. In phase II, the intervention improved perceptions of the safety and efficacy of mammograms with an absolute 15.4% increase in the respondents who believed that “A mammogram is the safest and most effective test available for finding early breast cancer.” Perceived barriers discouraging mammograms were access (17.0%), pain (13.2%), and education (13.1%).


Among an urban population of predominantly insured women with high rates of advanced breast cancer at diagnosis, personal factors and fear were cited as the greatest barriers to breast cancer screening. Educational intervention by CHWs showed a positive impact on respondents’ perceptions regarding mammogram safety and efficacy.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Affordable Health California. Affordable Care Act history. http://affordablehealthca.com/history-affordable-care-act/. Accessed 2 Aug 2017

  2. 2.

    McDavid K, Tucker TC, Sloggett A, Coleman MP (2003) Cancer survival in Kentucky and health insurance coverage. Arch Intern Med 163:2135–2144

    Article  PubMed  Google Scholar 

  3. 3.

    Ward E, Halpern M, Schrag N et al (2008) Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin 58:9–31

    Article  PubMed  Google Scholar 

  4. 4.

    Rong X, Yang W, Garzon-Muvdi T et al (2016) Influence of insurance status on survival of adults with glioblastoma multiforme: a population-based study. Cancer 122:3157–3165

    Article  PubMed  Google Scholar 

  5. 5.

    Markt SC, Lago-Hernandez CA, Miller RE et al (2016) Insurance status and disparities in disease presentation, treatment, and outcomes for men with germ cell tumors. Cancer 122:3127–3135

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Singh P, Sachs JD (2013) 1 Million community health workers in sub-Saharan Africa by 2015. Lancet 382:363–365

    Article  PubMed  Google Scholar 

  7. 7.

    Bhutta Z, Lassi Z, Pariyo G, Huicho L (2010) Global experience of community health workers for delivery of health related millennium development goals: a systematic review, country case studies, and recommendations for integration into national health systems. Geneva: World Health Organization. http://www.who.int/workforcealliance/knowledge/resources/chwreport/en/. Accessed 2 Aug 2017

  8. 8.

    Singh P, Chokshi DA (2013) Community health workers—a local solution to a global problem. N Engl J Med 369:894–896

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Maxwell AE, Bastani R, Danao LL et al (2010) Results of a community-based randomized trial to increase colorectal cancer screening among Filipino Americans. Am J Public Health 100:2228–2234

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Carney PA, Lee-Lin F, Mongoue-Tchokote S et al (2014) Improving colorectal cancer screening in Asian Americans: results of a randomized intervention study. Cancer 120:1702–1712

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Nguyen BH, Stewart SL, Nguyen TT et al (2015) Effectiveness of lay health worker outreach in reducing disparities in colorectal cancer screening in Vietnamese Americans. Am J Public Health 105:2083–2089

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Feltner FJ, Ely GE, Whitler ET et al (2012) Effectiveness of community health workers in providing outreach and education for colorectal cancer screening in Appalachian Kentucky. Soc Work Health Care 51:430–440

    Article  PubMed  Google Scholar 

  13. 13.

    Han HR, Song Y, Kim M et al (2017) Breast and cervical cancer screening literacy among Korean American Women: a community health worker-led intervention. Am J Public Health 107:159–165

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Mojica CM, Morales-Campos DY, Carmona CM et al (2016) Breast, cervical, and colorectal cancer education and navigation: results of a community health worker intervention. Health Promot Pract 17:353–363

    Article  PubMed  Google Scholar 

  15. 15.

    Nguyen TT, Le G, Nguyen T et al (2009) Breast cancer screening among Vietnamese Americans: a randomized controlled trial of lay health worker outreach. Am J Prev Med 37:306–313

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Wells KJ, Luque JS, Miladinovic B et al (2011) Do community health worker interventions improve rates of screening mammography in the United States? A systematic review. Cancer Epidemiol Biomark Prev 20:1580–1598

    Article  Google Scholar 

  17. 17.

    DC office of planning. Demographic and housing profiles 2010 by ward. https://planning.dc.gov/node/596612. Accessed 2 Aug 2017

  18. 18.

    District of Columbia Cancer Registry Bureau of Cancer and Chronic Diseases Community Health Administration. Burden of cancer in the District of Columbia. April 2014. https://doh.dc.gov/sites/default/files/dc/sites/doh/DOH_BurdenOfCancer_V5.pdf. Accessed 14 Aug 2017

  19. 19.

    American Cancer Society. Cancer facts & figures for African Americans: 2016–2018. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-facts-and-figures-for-african-americans/cancer-facts-and-figures-for-african-americans-2016-2018.pdf. Accessed 2 Aug 2017

  20. 20.

    Jatoi I, Chen BE, Anderson WF, Rosenberg PS (2007) Breast cancer mortality trends in the United States according to estrogen receptor status and age at diagnosis. J Clin Oncol 25:1683–1690

    Article  PubMed  Google Scholar 

  21. 21.

    Halpern MT, Brawley OW (2016) Insurance status, health equity, and the cancer care continuum. Cancer 122:3106–3109

    Article  PubMed  Google Scholar 

  22. 22.

    Crump SR, Mayberry RM, Taylor BD et al (2000) Factors related to noncompliance with screening mammogram appointments among low-income African American women. J Natl Med Assoc 92:237–246

    CAS  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Steele SL, Lewis-Jack O (2005) Psychological and neuropsychological predictors of non-compliance to mammography screening among high-risk African American women. Annual Summary Report. US Army Medical Research and Materiel Command, Fort Derick

    Google Scholar 

  24. 24.

    Davis C (2014) A comparison of compliance and noncompliance in breast cancer screening among African American women. Presented at the Annual Conference of the Society for Social Work and Research. January 18, 2014. San Antonio, TX

Download references


The authors wish to thank the patients and investigators who participated in this study, T. Blaise Springfield of Georgetown University for his help with manuscript development, and Phillips Gilmore Oncology Communications for editorial assistance.


The work was funded by the Avon Foundation for Women (Breast Cancer Safety Net Grants 05-2014-018 and 05-2015-015); the Four Seasons Hotel, Washington, DC; and MedStar Health Research Institute, Washington, DC.

Author information



Corresponding author

Correspondence to Elmer E. Huerta.

Ethics declarations

Conflict of interest

The authors declare that they have no financial relationships or conflicts of interest to report.

Ethical approval

All human investigations were performed after approval by the MedStar Health Research Institute Institutional Review Board (“IRB”) in accordance with an assurance registered under FWA00000504 filed with and approved by the U.S. Department of Health and Human Services.

Informed consent

Documentation of consent was waived by the IRB given that all surveys administered during study implementation were anonymized.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 2898 kb)

Supplementary material 2 (DOCX 30 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Huerta, E.E., Weeks-Coulthurst, P., Williams, C. et al. Take care of your neighborhood. Breast Cancer Res Treat 167, 225–234 (2018). https://doi.org/10.1007/s10549-017-4492-1

Download citation


  • Breast cancer
  • Community health worker
  • Disparity
  • Health insurance
  • Mammogram