Overcoming cultural barriers to mammography screening: Reaching Latinas with diabetes

Latinas experience health disparities in both breast cancer and diabetes. Latinas have a lower survival rate than non-Latina white women, due predominantly to later diagnosis. Latino mortality rates of Type 2 diabetes are 1.5 times higher than non-Latino groups. Breast cancer and diabetes are linked in two ways that may be used to reduce disparities for both illnesses for Latinas. First, obesity/overweight and inactivity – both preventable – are leading risk factors for both breast cancer and diabetes for Latinas. Second, women with diabetes are less likely to receive age-appropriate mammography despite more health visits (where the complexity of caring for chronic illness is predicted to interfere with mammography).

A collaboration between a community health center, a grass roots breast cancer community group, and a university-based academic team proposed a pilot study to examine the feasibility and potential effects of a systems-level intervention to improve mammography screening for diabetic Latina patients in a primarily farmworking Mexican community. The collaboration also sought to improve the infrastructure and capacity for community-based participatory research. The intervention built on an existing diabetes program to encourage self-management. Intervention components included a diabetes progress chart note designed to prompt for screening, a life-size “cut-out” poster of a physician with motion-activated message to promote screening in the waiting room, a brief guide to promote provider-patient discussion on behavioral risk factors related to diabetes and breast cancer, a one-time brief educational presentation to physicians, and ongoing monitoring and tailoring of the intervention with community advisory board consisting of diabetes and breast cancer stakeholders. Intervention components were designed to be easily implemented and sustainable by clinic and community members. Effects of the 6-month intervention will be examined for up to one year through a pre-post intervention, control-intervention group study design (N=45 and 77, respectively). Primary outcome measures are referral and receipt of a mammogram assessed through chart review. Patient telephone surveys assessed personal, cultural, and environmental correlates.

Preliminary findings from baseline and process evaluation measures indicate that Latinas are missing opportunities for age-appropriate mammography screening (47% and 27% compliance for intervention and control groups, respectively). The systems intervention is exposing providers and patients to more opportunities for exchange related to mammography. Integrating intervention to improve mammography screening with diabetes care may be an acceptable method to address disparities in screening and subsequent morbidity and mortality among Latina patients.