Breast Cancer Screening in a Low Income Managed Care Population

Low income women experience more morbidity and a shorter survival compared to more affluent women. Yet these women are least likely to avail themselves of screening and early detection testing which has been previously demonstrated to be associated with prolongation of survival for women subsequently diagnosed with breast cancer. The goal of this project is to increase screening and early detection practices in low income women, forty years and older, who are enrolled in a statewide HMO. It compares the relative effectiveness of two interventions (a simple one using a letter of invitation and a more intensive step-wise intervention of two sequential letters and follow-up counseling and home visits). Both interventions are compared with a control group of women who continue to receive their usual care. This report gives an account of program planning and process evaluation. The results of the baseline survey across groups are presented. A most significant finding was the difficulty of locating and contacting subjects who were literally hard-to-reach. Detailed data are provided illustrating the scope of this problem. Baseline survey data analysis is in process and intervention among groups is being initiated.