Community-based cancer screening for underserved women: design and baseline findings from the Breast and Cervical Cancer Intervention Study

Prev Med. 2001 Sep;33(3):190-203. doi: 10.1006/pmed.2001.0871.


Background: Underutilization of breast and cervical cancer screening has been observed in many ethnic groups and underserved populations. Effective community-based interventions are needed to eliminate disparities in screening rates and thus to improve prospects for survival.

Methods: The Breast and Cervical Cancer Intervention Study was a controlled trial of three interventions in the San Francisco Bay Area from 1993 to 1996: (1) community-based lay health worker outreach; (2) clinic-based provider training and reminder system; and (3) patient navigator for follow-up of abnormal screening results. Study design and a description of the interventions are reported along with baseline results of a household survey conducted in four languages among 1599 women, aged 40-75.

Results: Seventy-six percent of women ages 40 and over had had at least one mammogram, and most had had a clinical breast examination (88%) and Pap smear (89%). Rates were significantly lower for non-English-speaking Latinas and Chinese women (56 and 32%, respectively, for mammography), and maintenance screening (three mammograms in the past 5 years) varied from 7% (non-English-speaking Chinese) to 53% (Blacks). Pap smear screening in the past 3 years was low among non-English-speaking Latinas (72%) and markedly lower among non-English-speaking Chinese women (24%). The strongest predictors of screening behavior were having private health insurance and frequent use of medical services. Having a regular clinic and speaking English were also important. Race/ethnicity, education, household income, and employment status were, overall, not significant predictors of screening behavior.

Conclusions: These baseline results support the importance of cancer screening interventions targeted to persons of foreign origin, particularly those less acculturated.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / prevention & control*
  • Female
  • Humans
  • Mass Screening / organization & administration*
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Patient Acceptance of Health Care*
  • Poverty Areas
  • San Francisco
  • Uterine Cervical Neoplasms / prevention & control*
  • Women's Health Services / organization & administration*