In the United States, breast cancer remains one of the most diagnosed cancers among females and remains the second leading cause of cancer death. In addition, breast cancer is most likely diagnosed at an advanced stage among Hispanic females in the United States due to lower mammogram utilization.
Aims
The objective of this study was to determine the effectiveness of a multilevel, multicomponent community-based breast cancer screening intervention called the Breast Cancer Education Screening and NavigaTion (BEST) program. The primary outcome was the completion of a screening mammogram 4 months post-intervention.
Method
We used a pragmatic approach for evaluation, utilizing a quasi-experimental delayed intervention design. We recruited women from the community aged between 50 and 75, uninsured or underinsured, and overdue for screening.
Results
Six hundred participants were recruited (300 intervention and 300 control). Among completers, the screening rate was 97% in the intervention group and 4.4% in the control group (RR = 22.2, 95% CI: 12.5–39.7, p < .001). In multivariable analysis, age ≥ 65 (RR = 1.29, p = .047), perceived benefits (RR = 1.04, p = .026), curability (RR = 1.24, p < .001), subjective norms (RR = 1.14, p = .014), and fatalism (RR = .96, p = .004) remained significantly associated with screening outcome.
Conclusion
A multicomponent, bilingual, and culturally tailored intervention effectively facilitated breast cancer screening completion in an underserved population of Hispanic women. Individuals with improved screening outcomes were more likely to have higher positive beliefs. Our study has important implications regarding using multicomponent interventions in increasing breast cancer screening completion in poorly screened populations. It also highlights differences in health belief motivation for breast cancer screening completion.
Abraído-LanzaA. F.ChaoM. T.GatesC. Y. (2005). Acculturation and cancer screening among Latinas: Results from the National Health Interview Survey. Annals of Behavioral Medicine, 29(1), 22–28. https://doi.org/10.1207/s15324796abm2901_4
Centers for Disease Control and Prevention. (2012). Cancer screening—United States, 2010(Morbidity and Mortality Weekly Report., Issue. E.). Office of Surveillance, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services.
7.
ChampionV.SkinnerC. S.MenonU. (2005). Development of a self-efficacy scale for mammography. Research in Nursing and Health, 28(4), 329–336. https://doi.org/10.1002/nur.20088
8.
ChampionV. L. (1999). Revised susceptibility, benefits, and barriers scale for mammography screening. Research in Nursing and Health, 22, 341–348.
9.
ChampionV. L.SkinnerC. S.MenonU.RawlS.GieslerR. B.MonahanP.DaggyJ. (2004). A breast cancer fear scale: Psychometric development. Journal of Health Psychology, 9(6), 753–762. https://doi.org/10.1177/1359105304045383
10.
CoughlinS. S.RichardsT. B.NasseriK.WeissN. S.WigginsC. L.SaraiyaM.StinchcombD. G.VensorV. M.NielsonC. M. (2008). Cervical cancer incidence in the United States in the US-Mexico border region, 1998-2003. Cancer, 113(Suppl. 10), 2964–2973. https://doi.org/10.1002/cncr.23748
11.
DwivediA. K.MallawaarachchiI.LeeS.TarwaterP. (2014). Methods for estimating relative risk in studies of common binary outcomes. Journal of Applied Statistics, 41, 484–500.
12.
ErsinF.GözükaraF.PolatP.ErçetinG.BozkurtM. E. (2015). Determining the health beliefs and breast cancer fear levels of women regarding mammography. Turkish Journal of Medical Sciences, 45(4), 775–781. https://www.ncbi.nlm.nih.gov/pubmed/26422845
13.
FleissJ. L. (2003). Statistical methods for rates and proportions (2nd ed.). John Wiley.
14.
GorinS. S.BadrH.KrebsP.Prabhu DasI. (2012). Multilevel interventions and racial/ethnic health disparities. Journal of the National Cancer Institute Monographs, 2012(44), 100–111. https://doi.org/10.1093/jncimonographs/lgs015
15.
GuilleminF.BombardierC.BeatonD. (1993). Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines. Journal of Clinical Epidemiology, 46(12), 1417–1432. https://doi.org/10.1016/0895-4356(93)90142-n
16.
HansenL. K.FeiglP.ModianoM. R.LopezJ. A.Escobedo SluderS.MoinpourC. M.PaulerD. K.MeyskensF. L. (2005). An educational program to increase cervical and breast cancer screening in Hispanic women: A Southwest Oncology Group study. Cancer Nursing, 28(1), 47–53. https://doi.org/10.1097/00002820-200501000-00007
17.
HayJ. L.McCaulK. D.MagnanR. E. (2006). Does worry about breast cancer predict screening behaviors? A meta-analysis of the prospective evidence. Preventive Medicine, 42(6), 401–408. https://doi.org/10.1016/j.ypmed.2006.03.002
Institute of Medicine Committee on, U., Eliminating, R., & Ethnic Disparities in Health, C. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care (SmedleyB. D.StithA. Y.NelsonA. R., Eds.). National Academies Press. https://doi.org/10.17226/12875
20.
IqbalJ.GinsburgO.RochonP. A.SunP.NarodS. A. (2015). Differences in breast cancer stage at diagnosis and cancer-specific survival by race and ethnicity in the United States. Journal of the American Medical Association, 313(2), 165–173. https://doi.org/10.1001/jama.2014.17322
21.
LantzP. M.MujahidM.SchwartzK.JanzN. K.FagerlinA.SalemB.LiuL.DeapenD.KatzS. J. (2006). The influence of race, ethnicity, and individual socioeconomic factors on breast cancer stage at diagnosis. American Journal of Public Health, 96(12), 2173–2178. https://doi.org/10.2105/AJPH.2005.072132
22.
LarkeyL. K.HermanP. M.RoeD. J.GarciaF.LopezA. M.GonzalezJ.PereraP. N.SabodaK. (2012). A cancer screening intervention for underserved Latina women by lay educators. Journal of Women’s Health (Larchmt), 21(5), 557–566. https://doi.org/10.1089/jwh.2011.3087
23.
LivaudaisJ. C.CoronadoG. D.EspinozaN.IslasI.IbarraG.ThompsonB. (2010). Educating Hispanic women about breast cancer prevention: Evaluation of a home-based promotora-led intervention. Journal of Women’s Health (Larchmt), 19(11), 2049–2056. https://doi.org/10.1089/jwh.2009.1733
24.
Medina-ShepherdR.KleierJ. A. (2010). Spanish translation and adaptation of Victoria Champion’s Health Belief Model Scales for breast cancer screening–Mammography. Cancer Nursing, 33(2), 93–101. https://doi.org/10.1097/NCC.0b013e3181c75d7b
25.
MillerK. D.OrtizA. P.PinheiroP. S.BandiP.MinihanA.FuchsH. E.Martinez TysonD.Tortolero-LunaG.FedewaS. A.JemalA. M.SiegelR. L. (2021). Cancer statistics for the US Hispanic/Latino population, 2021. CA: A Cancer Journal for Clinicians, 71(6), 466–487. https://doi.org/10.3322/caac.21695
26.
MolinaY.ThompsonB.EspinozaN.CeballosR. (2013). Breast cancer interventions serving US-based Latinas: Current approaches and directions. Womens Health (London), 9(4), 335–348; Quiz 349–350. https://doi.org/10.2217/whe.13.30
27.
MooreJ. X.RoystonK. J.LangstonM. E.GriffinR.HidalgoB.WangH. E.ColditzG.AkinyemijuT. (2018). Mapping hot spots of breast cancer mortality in the United States: Place matters for Blacks and Hispanics. Cancer Causes & Control, 29(8), 737–750. https://doi.org/10.1007/s10552-018-1051-y
28.
NavarroA. M.SennK. L.McNicholasL. J.KaplanR. M.RoppéB.CampoM. C. (1998). Por La Vida model intervention enhances use of cancer screening tests among Latinas. American Journal of Preventive Medicine, 15(1), 32–41. https://doi.org/10.1016/s0749-3797(98)00023-3
NuñoT.MartinezM. E.HarrisR.GarcíaF. (2011). A Promotora-administered group education intervention to promote breast and cervical cancer screening in a rural community along the U.S.-Mexico border: A randomized controlled trial. Cancer Causes & Control, 22(3), 367–374. https://doi.org/10.1007/s10552-010-9705-4
31.
O’MalleyA. S.KernerJ.JohnsonA. E.MandelblattJ. (1999). Acculturation and breast cancer screening among Hispanic women in New York City. American Journal of Public Health, 89(2), 219–227. https://doi.org/10.2105/ajph.89.2.219
Parra-MedinaD.Morales-CamposD. Y.MojicaC.RamirezA. G. (2015). Promotora outreach, education and navigation support for HPV vaccination to Hispanic women with unvaccinated daughters. Journal of Cancer Education, 30(2), 353–359. https://doi.org/10.1007/s13187-014-0680-4
34.
PaskettE.ThompsonB.AmmermanA. S.OrtegaA. N.MarstellerJ.RichardsonD. (2016). Multilevel interventions to address health disparities show promise in improving population health. Health Affairs (Millwood), 35(8), 1429–1434. https://doi.org/10.1377/hlthaff.2015.1360
35.
PoweB. (1995). Cancer fatalism among elderly caucasians and African Americans. Nursing Outlook, 22, 1355–1359.
36.
PressR.CarrasquilloO.SciaccaR. R.GiardinaE. G. (2008). Racial/ethnic disparities in time to follow-up after an abnormal mammogram. Journal of Women’s Health (Larchmt), 17(6), 923–930. https://doi.org/10.1089/jwh.2007.0402
37.
RichmanA. R.TorresE.WuQ.KampschroederA. P. (2020). Evaluating a community-based breast cancer prevention program for rural underserved Latina and Black Women. Journal of Community Health, 45(6), 1205–1210. https://doi.org/10.1007/s10900-020-00856-2
38.
RosenstockI. (1975). Patients’ compliance with health regimens. Journal of the American Medical Association, 234, 402–403.
39.
Saei Ghare NazM.SimbarM.Rashidi FakariF.GhasemiV. (2018). Effects of model-based interventions on breast cancer screening behavior of women: A systematic review. Asian Pacific Journal of Cancer Prevention, 19(8), 2031–2041. https://doi.org/10.22034/apjcp.2018.19.8.2031
40.
Smith-BindmanR.MigliorettiD. L.LurieN.AbrahamL.BarbashR. B.StrzelczykJ.DignanM.BarlowW. E.BeasleyC. M.KerlikowskeK. (2006). Does utilization of screening mammography explain racial and ethnic differences in breast cancer?Annals of Internal Medicine, 144(8), 541–553. https://doi.org/10.7326/0003-4819-144-8-200604180-00004
StuverS. O.ZhuJ.SimchowitzB.HassettM. J.ShulmanL. N.WeingartS. N. (2011). Identifying women at risk of delayed breast cancer diagnosis. Joint Commission Journal on Quality and Patient Safety, 37(12), 568–575. https://doi.org/10.1016/s1553-7250(11)37073-0
43.
Surveillance Epidemiology, a. E. R. S. P. (2008). SEER stat database: Mortality—allCOD, aggregated with state, total US (1969–2005). National Cancer Institute. https://seer.cancer.gov/
WhiteA.ThompsonT. D.WhiteM. C.SabatinoS. A.de MoorJ.Doria-RoseP. V.GeigerA. M.RichardsonL. C. (2017). Cancer screening test use–United States, 2015. MMWR Morbidity and Mortality Weekly Report, 66(8), 201–206. https://doi.org/10.15585/mmwr.mm6608a1
47.
WhiteK.GarcesI. C.BanduraL.McGuireA. A.ScarinciI. C. (2012). Design and evaluation of a theory-based, culturally relevant outreach model for breast and cervical cancer screening for Latina immigrants. Ethnicity & Disease, 22(3), 274–280. https://www.ncbi.nlm.nih.gov/pubmed/22870569
48.
WintersS.AlomariA.ShokarG.MartinC.DwivediA.ShokarN. K. (2021). Breast cancer screening outcomes among Mexican-origin Hispanic women participating in a breast cancer screening program. Preventive Medicine Reports, 24, 101561. https://doi.org/10.1016/j.pmedr.2021.101561
