The number of rural, low-income women who choose to get mammograms may dramatically increase if those women get their health information from trained lay advisers in their own community, a new study shows.
The effect was consistent across the three racial groups included in the study. “Our results show that lay health advisers can improve the rates of mammography screening among low-income, rural white, African-American and Native American women,” says principal investigator Electra D. Paskett, who is a professor in the College of Medicine and School of Public Health at Ohio State. The findings of the Robeson County Outreach Screening and Education (ROSE) Project will appear in the Sept. 6 issue of the Journal of the National Cancer Institute. Regular mammograms and clinical breast exams can detect breast cancer early and reduce mortality from the disease. But mammography is underused by certain groups of women, particularly rural, poor and minority women. Such women typically fall into the category of ‘rarely or never screened’ for cancer and are considered high-risk populations, said Paskett, associate director for population sciences at the Ohio State University Comprehensive Cancer Centre-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. The goal of this study was to increase awareness of the benefits of early breast-cancer detection, encourage women to seek breast-cancer screening and to identify and reduce barriers that kept women from getting mammograms. The four-year study began in 1998 in rural North Carolina, said Paskett. She began the work while at the Wake Forest University School of Medicine before coming to Ohio State in 2002. The study involved 851 rural, low-income white, Native American and African American women, ages 40 or older, who had not gotten a mammogram in the past year. Each woman completed a survey about her knowledge and use of breast-and cervical-cancer screening. The participants were randomly assigned to either a group that received home visits from a lay health adviser or to a comparison group. The comparison group received a letter and a National Cancer Institute brochure about the need for regular cervical cancer screening. Women in the intervention group received three in-person home visits over a nine- to 12-month period. During the home visits, the lay health advisers discussed mammography, breast cancer, breast self-exam and scheduling a mammogram. They also provided educational materials about cancer risk and how to obtain mammograms. Follow-up phone calls were made to help participants make mammography appointments and to encourage women to discuss their mammogram experiences. After 12 to 14 months, participants were asked to complete a follow-up survey. The researchers also checked medical records to verify rates of mammography use. Three months after completing the follow-up survey, women in the comparison group were sent a letter inviting them to obtain a free mammogram, along with a brochure about mammography from the National Cancer Institute. Barriers identified by the study that most often kept women from receiving mammograms were perceived cost (54 percent) and lack of encouragement (45 percent), and the beliefs that radiation from the procedure cause cancer (41 percent) and that mammograms hurt (41 percent). The women could cite more than one barrier. In all, 42 percent of the women in the LHA group received a mammogram vs. 27 percent in the control group, resulting in 66 additional mammograms. “The intervention improved knowledge and beliefs about mammography screening,” said Paskett, who is also a professor in the School of Public Health. “We empowered these women to realise that they can schedule a mammogram on their own, with or without encouragement from their doctors.”(Source: Journal of the National Cancer Institute: Ohio State University: September 2006).