Cancer prevention in Indian Country: An evaluation of breast cancer screening efforts of the Hopi Women's Health Program

In 1996, the Hopi Women's Health Program (HWHP) was created to increase cancer screenings on the Hopi reservation. This was motivated by the results of a 1993 study conducted in collaboration with the University of Arizona (UA) that indicated only 45% of Hopi women over age 50 ever received a mammogram and 26% had one within the preceding two years. Recently, the HWHP requested assistance in evaluating the effectiveness of its efforts. Frequent communication identified questions to be asked, data sources, and format for presentation. Numerous challenges to the program's effectiveness were identified: long distances to travel for appointments (population density = 2.7 persons per square mile) and for providing transportation to appointments or making home visits (Hopi case managers traveled 30,000 miles in 1 year alone), limited telephone access (32% of occupied housing units have no telephones), and limited personal transportation (25% of housing units have no vehicle). In spite of these challenges, program data indicate that the HWHP has screened more than 80% of Hopi women age 40-64 and that these women are returning yearly for screening. A very high proportion of these women were never screened before: 57% of those age 40-49 and 35% of those aged 50-59. In addition, data indicate that the HWHP has been effective in reaching non-Hopi community members. 25% of all mammograms screenings and 31% of the women never previously screened were not enrolled tribal members. Implementation of HWHP has proven to be an effective strategy for increasing cancer screening.