Need: We know that breast cancer morbidity and mortality can be reduced through screening and early detection yet the Komen Foundation estimates only 21% of uninsured women over 50 in Central Texas received mammography screening between 2012-2017. Breast cancer morbidity and mortality are linked to lack of access to mammography, diagnostic services, and treatment and, due to the lack of those services, both Bastrop and Caldwell Counties are ranked by Komen as having the highest need for intervention to achieve Healthy People 2020 targets for both breast cancer morbidity and mortality. We know from other studies that major contributors to low screening rates are getting a recommendation to ge...

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Need: We know that breast cancer morbidity and mortality can be reduced through screening and early detection yet the Komen Foundation estimates only 21% of uninsured women over 50 in Central Texas received mammography screening between 2012-2017. Breast cancer morbidity and mortality are linked to lack of access to mammography, diagnostic services, and treatment and, due to the lack of those services, both Bastrop and Caldwell Counties are ranked by Komen as having the highest need for intervention to achieve Healthy People 2020 targets for both breast cancer morbidity and mortality. We know from other studies that major contributors to low screening rates are getting a recommendation to get screened and ability to pay for and accessibility of mammography. We plan to address these barriers by providing outreach, education, and mobile mammography services, regardless of ability to pay, to women in the highest risk counties in Central Texas: Bastrop, Caldwell, and Travis. Overall Project Strategy: Lone Star Circle of Care, Dell Medical School, and the Central Texas Addressing Cancer Together coalition, will collaborate to provide outreach, education, and mobile mammography services to un- and under-insured women in Bastrop, Caldwell, and Travis Counties for the duration of the award. For those women with abnormal mammograms, we will navigate them to diagnostic imaging and biopsy, if necessary, and get them treatment if diagnosed with breast cancer. We will collect survey and qualitative data that will allow us to tailor and successfully sustain and disseminate mobile mammography screening in this high need population. Through these efforts, we will have created a sustainable system for delivering outreach and mammography services in Central Texas. Specific Goals: Our goals are (1) to provide outreach and culturally-appropriate education through community sources regarding the value of breast cancer screening and how to access the mobile mammography services, reaching at least 3,656 women in Bastrop, Caldwell, and Travis Counties, (2) to increase the conservatively estimated current mammography screening rate from 43% to 60% among un- and under-insured women aged 50-74 in Bastrop, Caldwell, and Travis Counties who have not been screened in the last two years and (3) navigate 90% of those with abnormal mammograms to additional diagnostic imaging and, if necessary biopsy. Using Centers for Disease Control estimates and known population demographics, we need to screen 385 women in Bastrop, 171 in Caldwell, and 3,100 women in Travis Counties for a total of 3,656 women to meet our goal of increasing the mammography screening rate to 60% in these three counties. Of the women screened, we estimate 15% or 548 will need diagnostic imaging, 10% of them or 54 will need biopsy with 2-3 out of every 1,000 women screened, or conservatively 8-11 women will be diagnosed with breast cancer. While treatment is not paid for by this funding, we will have funding for uninsured women to be treated either through the Medicaid for Breast and Cervical Cancer program or by our specialty collaborators (see Letters of Support). We will collect demographic and other data from women being screened to better understand what social and other factors impact their ability to get mammography and their perception of the value of mobile mammography compared with other means of mammography delivery. We will also conduct qualitative interviews with 30 women screened, all members of the mobile mammography team, and 10 community partners to get a more in-depth understanding of the perception of mobile mammography services and women’s and communities’ experiences with the service. These interviews will inform the ongoing implementation of mobile mammography and will help us establish the sustainability of this effort by helping us tailor our outreach and service delivery to be most effective and efficient. Significance and Impact: Un- and under-insured women in the State of Texas have lower breast cancer screening rates than insured women. Women in Texas are at high risk of experiencing these disparities in breast cancer screening given that Texas has the highest rate of un-insurance in the nation. Increasing access to affordable, local mammography is one way to increase screening among these vulnerable women. Our work will increase screening in this population in three of the highest need counties, as well as awareness of the import of breast cancer screening among women and their communities. We will also collect data that will allow us to continue to tailor and sustain this program to meet the breast cancer screening needs of un- and under-insured women in Central Texas. Finally, we will have established a sustainable system for the delivery of breast cancer screening to vulnerable women in Central Texas.

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