AltaMed Health Services: Breast Cancer Outreach and Screening Program

Objective: Women living in Los Angeles and Orange County have low mammography screening history; only 65.6% of women have had a mammogram in the past 2 years or less.¹ Research has demonstrated that the primary reason women do not receive mammograms is the expense or lack of insurance.² Through a grant provided by the American Cancer Society, AltaMed Health Services (AltaMed) implemented a Breast Cancer Outreach and Screening Program with multiple elements. The overall program aims to provide breast health education and screening mammograms to eligible women who are patients at the West Covina, El Monte, and Santa Ana-Bristol clinics.

Methods: The program was multifaceted and included postcard mailings, patient incentives to attend their mammogram appointments, clinic staff training, clinic staff incentives, and a health education intervention led by a health promoter. Studies have proved that health promoter_based interventions increase breast health education and likelihood of mammography screening.^3-9 In order to improve communication, education, and ultimately participation for eligible women aged 50 to 74 years, health promoters at 3 clinics (West Covina, Santa Ana-Bristol, and El Monte) were assigned to make patient phone calls to women who received a postcard but did not come in for their screening. The health promoter provides language assistance and culturally sensitive education, answers questions or concerns the women may have about mammography screening, and ultimately encourages women to schedule a mammogram screening at no cost. If women have any transportation obstacles, they are offered a gas card or taxi voucher. During on-site mammogram days at the clinic, health promoters provide breast health education and promote preventive behaviors to women receiving mammograms.

Results: In year 1 of the project, AltaMed was able to increase its screening rate from 46% to 69% at the participating clinics. In year 2 of the project, which is still in progress, AltaMed has surpassed its goal of screening 1367 women at the 3 clinics by screening 1460 women as of July. It has already achieved a collective screening rate at the 3 clinics of 67%, which represents a 21% increase over the baseline.

Conclusion: The use of culturally and linguistically appropriate health education led by a health promoter is one aspect of a multipronged approach to addressing low breast cancer screening rates among uninsured and underserved Latinas. The systems and processes developed through this grant to increase breast cancer screenings at the 3 participating clinics are replicable and will be spread to additional AltaMed clinics with low breast cancer screening rates.

References

1. UCLA Center for Health Policy Research. AskCHIS 2019. Main reason for not having mammogram. http://ask.chis.ucla.edu. Accessed July 15, 2016.
2. UCLA Center for Health Policy Research. AskCHIS 2012. Mammogram screening history. http://ask.chis.ucla.edu. Accessed July 15, 2016.
3. Hansen LK, Feigl P, Modiano MR, et al. An educational program to increase cervical and breast cancer screening in Hispanic women: a Southwest Oncology Group study. Cancer Nurs. 2005;28:47-53.
4. Hiatt RA, Pasick RJ, Stewart S, et al. Community-based cancer screening for underserved women: design and baseline findings from the Breast and Cervical Cancer Intervention Study. Prev Med. 2001;33:190-203.
5. Larkey L. Las mujeres saludables: reaching Latinas for breast, cervical and colorectal cancer prevention and screening. J Community Health. 2006;31:69-77.
6. Livaudais JC, Coronado GD, Espinoza N, et al. Educating Hispanic women about breast cancer prevention: evaluation of a home-based promotora-led intervention. J Womens Health (Larchmt). 2010;19:2049-2056.
7. Molina Y, Thompson B, Espinoza N, et al. Breast cancer interventions serving US-based Latinas: current approaches and directions. Womens Health (Lond). 2013;9:335-348.
8. Sauaia A, Min SJ, Lack D, et al. Church-based breast cancer screening education: impact of two approaches on Latinas enrolled in public and private health insurance plans. Prev Chronic Dis. 2007;4:A99.
9. Valdez A, Banerjee K, Ackerson L, et al. A multimedia breast cancer education intervention for low-income Latinas. J Community Health. 2002;27:33-51.