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    Awarded Grants
    Increasing Repeat Mammography Screening Among Low-Income Filipino-American Women

    Scientific Abstract:
    Tracking Number POP0402997 Increasing Repeat Mammography Screening Among Low-Income Filipino American Women Background: The focus of this proposal is the low mammography rescreening rate among Filipino American women who are enrolled in the “Cancer Detection Program: Every Woman Counts” (formerly known as Breast Cancer Early Detection Program - BCEDP). This is of concern, given that all the evidence on the effectiveness of mammography in reducing mortality is based on repeat screening at regular intervals. Reflecting the rapidly growing Filipino population in California, a substantial number of Filipino women receive a mammogram through this program in California, about 2,000 per year. However, only 28% of all enrolled women receive a repeat screening mammogram within 18 months, which is less than half of the rate observed in the general population. Despite the fact that the program pays for annual mammograms, thereby eliminating an important cost barrier, repeat screening rates have been low since the onset of the program. Objective: An intervention to increase regular screening, that is culturally sensitive and tailored towards the specific needs of Filipino American women will be developed for and with significant input from the community. We will develop and pilot test such an intervention in collaboration with two community clinics that provide free mammograms under the program “Every Woman Counts” to Filipino American women. Specific Aims: (1) Develop one or more culturally targeted intervention(s) for Filipino women enrolled in “Every Woman Counts” to increase repeat screening rates, such as information that explains the importance of repeat screening, peer navigators, etc. (2) Pilot test the intervention(s) with approximately 150 Filipino women who are enrolled in “Every Woman Counts” and are due for rescreening to determine their acceptability, effect size and feasibility for implementation on an ongoing basis. Study Design: During the first 12 months of the study, we will conduct semi-structured in-depth one-on-one interviews with 40 Filipino women who have had a mammogram under “Every Woman Counts”. Guided by the theoretical framework of the Adherence Model we will identify misconceptions and barriers to screening that should be addressed in our intervention, facts that may encourage women to get screened on a regular basis and the formats that appear to be most desirable. Next we will present our findings to a group of Filipino women and staff from collaborating clinics in a brainstorming session to gather additional ideas for intervention messages. Drafts of interventions will be reviewed and revised by Filipino women in four focus groups. In the following 12 months, we will pilot test the interventions among Filipino women who are due for rescreening. We will review clinic records to assess rescreening rates (effectiveness), debrief women to assess acceptability, and estimate cost of the interventions to assess feasibility to implement them in the future. Potential Outcomes and Benefits of the Research: If we can design an intervention that leads to a substantial increase in regular breast cancer screening, it can be used statewide and serve as a model for similar programs for women of other ethnic/racial groups who are enrolled in “Every Woman Counts”. Improving screening on a regular basis will lead to the detection of breast cancer at an earlier stage, which will improve treatment, survival and quality of life of many women in this low-income and underserved population.

    Lay Abstract:
    Tracking Number POP0402997 Increasing Repeat Mammography Screening Among Low-Income Filipino American Women Eliminating racial and ethnic health disparities is a major priority in California, which has by far the largest Asian American and Pacific Islander population in the country (4.4 million). After Chinese, Filipinos are the second most populous group in California (N=918,678). Almost 30% of Filipinos in California reside in Los Angeles County (N=260,158). More than 70% of Filipino Americans are foreign born and more than 25% do not speak English very well. The per capita income of Filipinos in Los Angeles County is $14,272, as compared to $24,938 among Non-Hispanic Whites. Given that Filipinos are one of the fastest growing segments of the population due primarily to immigration, Filipino women constitute an important group that is underserved with respect to cancer screening. Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death among Filipino women. The incidence of breast cancer in Filipino women residing in California is 98.1 per 100,000, which is higher than that experienced by Hispanic women, but lower than in African or White women. Pilot data from a prior study suggest that only 26% of low-income Filipino women obtain regular mammograms, as recommended by the guidelines. Given these statistics, programs that offer free or low-cost breast cancer screening are crucial. In Los Angeles County there are several clinics and community based organizations that conduct outreach specifically to Filipino women and provide free clinical breast exams and mammography screening through the “Cancer Detection Program: Every Woman Counts” (formerly known as Breast Cancer Early Detection Program - BCEDP). While providers in Los Angeles County are very successful in enrolling Filipino women, repeat screening rates remain much lower than in the general population: Only 28% of all women enrolled in “Every Women Counts” receive a repeat screening mammogram within 18 months as compared to 60-70% of women in the general population. Our research team has partnered with two clinics to address this disparity. We will develop one or more culturally targeted intervention(s) for Filipino women enrolled in “Every Woman Counts” to increase repeat screening rates. These interventions may include information that explains the importance of repeat screening, that could be conveyed via print materials, or in telephone calls by trained peer navigators or health professionals. These interventions will then be pilot tested with approximately 150 Filipino women who are enrolled in “Every Woman Counts” and who are due for rescreening to determine their acceptability, effect size and feasibility for implementation on an ongoing basis. If this pilot study shows that our interventions lead to a clinically important increase in repeat screening, we will apply for funding to rigorously test their effectiveness in partnership with several clinics in a randomized trial. If our interventions are found to be effective, they can have a positive impact on a large number of Filipino women, because they can be included in “Every Woman Counts” and similar programs nationwide. Improving screening on a regular basis will lead to the detection of breast cancer at an earlier stage, which will improve the treatment, survival and quality of life of many women in this low-income and underserved population.