The Socioeconomic Impact of Mobile Mammography

November 2020 Vol 11, No 11
Patrick Dineen, MD, MBA
Stony Brook Hospital, NY
Liana Orduña, BS
Stony Brook Hospital, NY
Darlene Rastelli, MS, RT, (R) (M)
Stony Brook Hospital, NY
Michelle Flores, BS
Stony Brook Hospital, NY
Monica Roggemann, BS
Stony Brook Hospital, NY

Background: Nassau and Suffolk counties on Long Island account for over 1500 breast cancer diagnoses annually. According to the New York State Department of Health, Suffolk leads the state with 38.5% of women eligible for a screening mammogram who do not participate, with Nassau at 21.4%. The state average is 20.3%. Despite the prevalence of breast cancer prevention campaigns over the past decade, many women still do not get a screening mammogram. Breast cancer remains the leading cancer diagnosed in women in New York State and the second leading cause of death.

Objective: The primary goal of this initiative was to increase the number of underserved women who receive a screening mammogram. Through our personal interaction with these women, we are able to understand and address the barriers that affect their access to healthcare. The barriers identified include lack of transportation, lack of insurance, distrust in the medical profession, financial insecurity, English as a second language, cultural norms, and lack of time for themselves.

Methods: A retrospective 6-month study of 3490 female patients at the Carol M. Baldwin Breast Care Center was completed. The data analyzed show that 78% of the women who receive a screening mammogram are white, 5% Hispanic/Latino, 5% African American, 3% Asian, 1% Native American/Pacific Islander, 1% other Asian, and 7% unknown. The Mobile Mammography Unit (MMU) visits churches, libraries, community centers, schools, supermarkets, federally qualified health centers, foundations, and local businesses. There is no cost to the host site, nor any out-of-pocket cost to the patients, and the screening mammogram is complete in just 15 minutes. Staff is bilingual and trained in cultural competency and health literacy. All women screened receive a survey after the mammogram and receive a follow-up reminder 1 year later.

Results: By eliminating the barriers of transportation, lack of insurance, financial obligations, distrust in the healthcare system, and by providing all paperwork and clinical staff fluent in their native language, the MMU gains the trust of the communities it serves. The patient population screened on the MMU since its inception is as follows: 58% Hispanic/Latino, 29% white, 9% African American, 3% Asian, and 1% American Indian. The MMU has screened over 2300 women in an 18-month period, diagnosing 14 breast abnormalities ranging from precancer to various stages of malignancy, with the majority being early-stage detections. The percentage of women who return to the MMU for their next scheduled mammogram is 95%.

Conclusion: The MMU provides a statistically significant increase in breast cancer screening in the underserved communities. The MMU travels within both Nassau and Suffolk counties, utilizes its bilingual staff, and collaborates with the New York State Cancer Services Program. This eliminates the barriers of transportation, cost, lost work time, and language barriers. By increasing the number of women who receive the recommended screening mammogram, the breast cancers diagnosed are at an early stage, thus providing an opportunity for better outcomes, lower mortality rates, less financial burden on the patient, and less strain on the healthcare system.

Sources

Fayanju OM, Kraenzle S, Drake BF. Perceived barriers to mammography among underserved women in a breast health center outreach program. Am J Surg. 2014;208:425-434.

New York State Department of Health. Percentage of Women Not Screened for Breast Cancer and Percentage of Priority Population Not Served by the Cancer Services Program. health.ny.gov. 2017.

Noonan AS. Improving the health of African Americans in the USA: an overdue opportunity for social justice. Public Health Review. 2016:12.

Pearlman DN, Rabowski W, Ehrich B, Clark MA. Breast cancer screening practices among black, Hispanic, and white women: reassessing differences. Am J Prevent Med. 1996;12:327-337.

Young RF, Schwart K, Booza J. Medical barriers to mammography screening of African American women in a high cancer mortality area: implications for cancer educators and health providers. J Cancer Educ. 2011;26:262-269.

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