Abstract B69: Outreach efforts for cervical and breast cancer prevention and control in Puerto Rico: Cultivando la Salud

Abstract

Background: Research has established that mammograms reduce breast cancer mortality, and regular Pap testing reduces both incidence and mortality from cervical cancer. Despite clear recommendations and benefits, Puerto Rican women remain disproportionally under-screened. Behavioral interventions in PR are scarce, therefore Puerto Rico Cancer Control Outreach Program (PRCCOP) trained lay health workers (Promotoras) to focus on increasing breast and cervical screening practices among non-adherent women. This effort was possible through a partnership with Taller Salud, a community based organization. Objectives: To summarizes the methodology of recruitment and intervention delivery of this population-based intervention among non-adherent women living in Canóvanas, PR. Methods: A systematic random sample of 444 women (236 intervention arm; 208 control arm). Eligible women were: 40+ years old with no mammogram in the past year or 21+ years old with no Pap test in the last 3 years. According to their non-adherence status, women were assigned to either a Mammography or a Pap group, and randomly assigned to intervention or control groups. We conducted a baseline survey that included questions about history of breast and Pap test screening, knowledge, perceptions and attitudes about breast and cervical cancer screening and sociodemographic characteristics. Promotoras delivered educational sessions to women in the intervention group. Follow-up surveys were conducted four months after the baseline survey (control group) or after intervention delivery (intervention group), to assess self-reported mammogram and Pap test screening rates. Results: Study period was July 2012-July 2013 and included collaboration from 25 interviewers and 12 Promotoras. Trainings for the Promotoras lasted about 8 hours and included topics such as: role of the Promotora, reaching women, finding breast cancer early, breast cancer screening: barriers and responses, Pap Test: barriers and responses, teaching methods, practices session using program materials and resources and referrals. Participation rate for the baseline survey was 94.8%. A total of 210 interventions (88.9%) were completed. Mean age of study participants was 50 ±14.1 years. Eighteen percent of the women 40+ years old reported never having a mammography, while 12.4% of the sample reported never having had a Pap in their lifetime. Over half of the participants had not completed high school (52%) and were married (58%). Almost two thirds of the sample reported having a household gross income of less than $19,999 and 9.5% reported having no medical plan. Fifty percent of the participants reported having Mi Salud, a governmental healthcare plan of Puerto Rico. Conclusions: The experience gained in this educational intervention will help establish similar studies island-wide. It also highlights the need to reach under screened women and maintaining efforts with Community Based Organizations to promote cancer screening among Puerto Rican women. Citation Format: Maria E. Fernandez, Vivian Colon-Lopez, Edna Acosta, Camille Velez, Natalie Fernandez, Marievelisse Soto-Salgado, Erick Suarez, Alana Feldman, Alelí Ayala Marín, Angela Pattatucci. Outreach efforts for cervical and breast cancer prevention and control in Puerto Rico: Cultivando la Salud. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B69. doi:10.1158/1538-7755.DISP13-B69

The Cancer Prevention and Control Research Network: An Interactive Systems Approach to Advancing Cancer Control Implementation Research and Practice

“…Preliminary results indicate that 35.0% and 37% of women in the intervention group received mammography and Pap test screening, respectively, representing a level two a half times greater than women in the comparison group (40). In Puerto Rico, the adapted CLS program similarly increased Pap test screening [OR, 2.34; 95% confidence interval (CI), 1.13–4.87] but not mammography (41). …”