Abstract A26: Multimodal approach to increasing breast cancer screening in rarely and never screened women in Jefferson County Kentucky: A preliminary analysis

Background: The cancer incidence and mortality rate in Jefferson County is among the highest in the nation and nearly half of women with breast cancer have not had a recent mammogram at the time of diagnosis. Mobile Health Units are in use in a number of communities, however, there is a paucity of data describing the outcomes of women utilizing these units. We sought evaluate the demographics of the population of women utilizing a mobile health unit and the ability of a mobile health unit to reach rarely and never screened, low income women.

Methods: We utilized Community Guide recommendations to encourage mammography screening on our Mobile Health Unit equipped with digital mammography and a clinical exam room. Women ≥ 40 without screening in > 1 year were eligible. We screened women in > 50 locations throughout Jefferson county, a county in which 11% overall are uninsured. The general population is 76% Caucasian, 20%African American, 4% other, 3% Hispanic. We utilized telephone reminders, offered no cost mammograms to the uninsured, one on one education and promoted screening via community partners and small media. After 6/08 we instituted a dedicated nurse navigator for follow up. We used geographic information system mapping to define areas of high poverty and high mortality (high need). We conducted a retrospective review of all women undergoing mammography screening on our unit during the period 3/08–10/08. We performed descriptive analysis, McNemar and Chi Square to determine the differences between two groups.

Results: Complete data were available for 746 women. The mean age was 53, 48% (359/746) were Caucasian, 47% (352/746) were African American, 5% were other races and 14% (102/746) were Hispanic/Latina. Forty-seven percent were not insured, 34% were privately insured, 14% were covered by Medicare or Medicaid, 5% not recorded. Thirty-one percent had never had a mammogram, or had not had one in > 5 years. Ninety-five women needed diagnostic follow up, 6 were suspicious for malignancy. The mean age of the 4 patients diagnosed with cancer was 51, none of whom initially had insurance. Two of the 4 were rarely/never screened. Adherence to follow-up was 80% before 6/08 and 92% after the navigator intervention. Forty- six percent were screened in a high need area. The rate of rarely/never screened was higher in the high need areas compared to the other screening locations 36% vs. 28%, p<0.01.

Conclusions: We successfully reached a large percentage of rarely and never screened women by deploying a Mobile Health Unit in partnership with community organizations and evidence based interventions. Individual counseling is critical to ensuring follow-up.