Understanding and Preventing Breast Cancer Disparities in Latinas

Screening Mammography and Latinas: A Multilevel Intervention [Fortaleza Latina]

Co-Project Leaders:

Shirley A. A. Beresford, PhD, Member, Cancer Prevention Program, Public Health Sciences, FHCRC

Gloria Coronado, PhD, Senior Investigator, Kaiser Permanente Center for Health Research

Health disparities are evident in rates of breast cancer screening; 42% of Hispanic women have had a mammogram in the past year compared to 53% of non-Hispanic white women. Lower mammography screening rates are thought to explain the relative late stage of detection and lower 5 year survival experienced by Hispanics compared to non-Hispanic whites.

The overall goal of the FORTALEZA LATINA project is to develop and test a culturally-appropriate multi-level intervention aimed at increasing screening mammography utilization in a clinic-based sample of Latino women in Western Washington. The intervention addresses both the social and physical context and individual demographic risk factors, as described in the conceptual model of Warnecke and colleagues.

The study will examine the effectiveness of the intervention in improving breast cancer screening rates via a three-arm individual randomized controlled trial. Cost-effectiveness data will be collected and analyzed to assess the cost per woman screened.

The primary aim for this project is to develop and implement a culturally-appropriate multi-level randomized intervention to increase use of screening services for breast cancer among age-eligible (40 - 74) Hispanic women in Western Washington who receive medical care at one of four clinics of Sea Mar Community Health Centers. The arms of the trial are:

  • A culturally-tailored clinic reminder system including a live telephone call and practical assistance for scheduling of mammography screening (low-intensity intervention);
  • A theory-based in-person visit using a motivational interviewing (MI) approach led by a promotora and a follow-up MI phone call (high-intensity intervention); and
  • Usual care.

 A partnership with the Seattle Cancer Care Alliance provides additional mammography services through on on-site state-of-the-art digital Mobile Mammography Van.

The intervention will be evaluated by assessing changes in the use of screening services for breast cancer (based on self-report and medical record review) in pair-wise comparison of the three arms, at one year following randomization. In addition to the primary aim, this project has two secondary aims, which are:

  • To assess and compare the costs associated with each of the two intervention arms in relation to the intervention effect (usual care as referent); and
  • To examine the relationship between neighborhood-level factors (such as the percent Hispanic and aggregated household income from Census data and self-reported factors such as neighborhood belonging) and mammography uptake, and test whether neighborhood factors modify the effectiveness of the intervention.

The study will evaluate the effectiveness of a multi-level intervention in increasing screening for breast cancer among Hispanic women.