Removing Barriers to Optimal Breast Cancer Screening May Improve Overall Survival

It may be time to adopt a business model to help women better navigate breast cancer care from screening to treatment, according to research presenters at the 2019 San Antonio Breast Cancer Symposium. Their findings indicate it may be possible to improve overall survival (OS) by removing barriers to receiving optimal mammography screening.

Breast cancer was the leading site of new cancers in Arizona in 2015 and there were 110.9 new breast cancer diagnoses per 100,000 women, according to the authors. The researchers looked at what barriers may be contributing to low screening rates among women in Pima County in Southern Arizona in the hope of developing a sustainable model to increase breast cancer screening among women.

Using Electronic Health Records, the researchers identified women between the ages of 40 and 75 who had been referred to or seen at a breast imaging clinic in Tucson, Arizona, (Pima County) between January 1, 2014, and September 30, 2017. The researchers then adapted a questionnaire, which already was validated in colon cancer, and measured screening knowledge, motivations and barriers to adherence, and self-efficacy.

The researchers selected a cohort of 9661 nonadherent patients from a clinic in Southern Arizona. In this cohort, 26% were Hispanic and 65% were non-Hispanic. With a total of 123 participants, they found that financial issues may be a barrier for some women. Among these 123 women, almost 50% had less than or a high school degree or equivalent.  For approximately 50% of the women, their monthly family income was $2000 or less. Knowledge gaps around mammography did not appear to be a problem. However, financial reasons were identified as a barrier (P =.05), however no Hispanic patients reported financial reasons to be a barrier.

The study showed that a high percentage of noncompliant women reported being compliant at another clinic. “The high number of declined due to compliant elsewhere points to the need to develop a business case to sustain lay navigators across the breast cancer continuum, from screening to diagnostic resolution, treatment, survivorship, and/or palliative care,” wrote the authors.

Reference

MacPherson AH, Gomez J, Caljoun E, et al. Identification of barriers to breast cancer screening that affect compliance. Poster presentation at: 2019 San Antonio Breast Cancer Symposium; December 10-14, 2019; San Antonio, TX. Abstract P6-11-13.