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.
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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.
Conflict of interest
The authors declare that they have no financial relationships or conflicts of interest to report.
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.
Documentation of consent was waived by the IRB given that all surveys administered during study implementation were anonymized.
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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
- Breast cancer
- Community health worker
- Health insurance