Community Services Navigation to Advance Health Equity in Breast Cancer Screening

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Project Abstract Community Services Navigation to Advance Health Equity in Breast Cancer Screening Persistent inequities in breast cancer outcomes can be traced in large part to inequities in breast cancer screening follow-up care among underserved women. While U.S. breast cancer mortality rates have decreased approximately 2% per year since 1990, socially and economically disadvantaged women have experienced increasing breast cancer mortality over that time. Many of these deaths are preventable. Mammography is evidence-based screening that, when fully implemented with appropriate follow-up care, improves outcomes for millions of women who are screened each year. Many services, including financial coverage, exist to improve breast screening rates among underserved women. Now, to address health disparities and promote health equity we must remove persistent barriers to appropriate follow-up of abnormal screening exams – the point of care with the most potential impact to decrease late-stage disease and mortality. Women with a higher burden of social needs (e.g., for food, housing, utilities, transportation), are about half as likely to follow-up after an abnormal mammogram than women who experience minimal social needs. There is a critical need to implement programs that will help women overcome barriers to follow-up, including access to community service resources, which is a known barrier. The SINCERE intervention, a validated screener and referral process for social needs (e.g., for transportation, housing, utilities, food), was found in our prior studies to be feasible and acceptable in Emergency Department settings. Building on this prior work, we now propose to adapt and extend the implementation of this intervention by adding community services navigation – an active outreach intervention to connect breast screening patients with social services. We aim to address the needs of underserved women that act as barriers to follow-up of abnormal breast screening and reduce breast cancer disparities. Our overarching objective is to improve health equity, and the goal of this study is to evaluate if adding community services navigation to the standard referral process for social needs is an effective and scalable strategy for addressing disparities in follow-up to abnormal breast cancer screening results. With statewide community service providers, existing health information technology, and validated methods, we will determine the effectiveness of social needs referrals combined with a community services navigation intervention in the screening mammography setting to improving breast screening outcomes in underserved women. We expect that outreach to underserved women, who represent a large proportion of late-stage and higher mortality breast cancers, will improve breast cancer screening follow-up and outcomes for underserved women.