The objective of this study is to explore the perceptions of under- and uninsured, Hispanic women living in Maricopa County around mammography screening to understand if deploying a BRCA model in community settings is a culturally acceptable strategy for reducing disparities in mammography access and use.
In 2019, breast cancer (BC) was the leading cause of death among Hispanic women in Maricopa County, Arizona (AZ) – Mayo Clinic Arizona’s (MCA) primary catchment area where Hispanics comprise 30% of the population. Mammography screening has been associated with a nearly 25% reduction in mortality, but Hispanic women have a lower incidence of mammography screening and are twice as likely to report barriers to accessing care compared to non-Hispanic White women. Federally Qualified Health Centers (FQHCs) are safety net providers that can help reduce disparities in mammography screening by providing screening services on site or referring patients to other clinics. Unfortunately, there is the only one FQHC in the County that provides screening on site. Preliminary data and feedback from community stakeholders suggest that the limited presence of mammography facilities, challenges accessing and affording health care, as well as other contextual factors (cultural beliefs, transportation, age, literacy) may explain disparities in BC screening and mortality.
Risk-based screening may bring considerable benefits by directing the limited screening and preventive resources available in Maricopa County to women most in need. Guideline recommendations call for the implementation of individualized breast cancer risk assessment (BRCA) in primary care settings, but implementation may prove challenging for FQHCs in Maricopa County that are chronically overburden and underresourced. This proposed research is significant for its potential to reduce disparities in BC screening and mortality by exploring the use of BRCA models in community settings as a strategy to identify Hispanic women at increased BC risk for targeted interventions.
Before this innovative strategy is introduced, we must understand women’s perceptions around risk, barriers to accessing mammography screening, and acceptability (i.e., attitudes, beliefs, barriers, and facilitators) of BRCA. The objective of this pilot study is to explore the cultural acceptability of performing BCRA in community settings as a strategy to promote access and use of mammography screening among under and uninsured, Hispanic women in Maricopa County.
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