Does Offering Free Breast Cancer Screenings Make a Difference?–A Retrospective 3-Year-Review of a West Texas Free Breast Cancer Screening Program

Objectives: We evaluated a single free breast cancer screening program for breast cancer rate per 1,000 mammograms and compared it to the national cancer rate. We aimed to determine compliance rate in previously noncompliant women, to determine recall rate, and to find the percentage of diagnostic imaging done as a first test on a previously unscreened population. Methods: A retrospective chart review of 523 free breast cancer screenings was performed from 2010-2013. Baseline demographics, mammogram screenings, and breast cancer diagnoses were assessed. A p-value of <0.05 was considered statistically significant. Results: Out of 523 screenings, 113 women had never received a previous mammogram. Screening breast cancer rate was found to be 2.4/1000. Breast cancer rate was found to be 92.6/1000 diagnostic mammograms. Breast cancer was detected in 11 women. Overall compliance rate was 21.9%. Of 523 mammograms included in our study, 20.7% were diagnostic on the first mammogram, while 79.3% were screening with a recall rate of 22.4%. Conclusions: Free breast clinics help bridge the gap between health disparities and are an asset to the community. More funding and effort needs to be allocated towards increasing the number of free breast clinics nationwide. Introduction According to Center for Disease Control and Prevention (CDC) statistics, breast cancer is the most common cancer in women, regardless of race or ethnicity, in the United States [1-3]. It is also the most common cause of death from cancer among Hispanic women and the second most common cause of death from cancer among white, African American (AA), Asian/Pacific Islander, and American Indian/Alaskan Native women [1]. Fortunately, with increased screening, detection methods, and improvements with innovation of breast cancer treatment, mortality has steadily decreased over the last decade in all races and ethnicities except for American Indian/Alaskan native women, for whom it has stayed constant [1]. The incidence of breast cancer has increased in young AA women by 0.5% per year while mortality rates have decreased [1]. This is likely attributed to increased screening for breast cancer in this population. Health disparities are evident in the field of breast cancer [4-24]. A few of the reasons cited include location segregation, lack of knowledge about breast cancer and breast cancer prevention, mistrust of the healthcare system, fatalism, and cultural and religious reasons. The movement towards improvement in breast cancer prevention, detection, and treatment was addressed in the Healthy People 2010 and 2020 reports [25]. One of the goals listed in Healthy People 2020 is to completely eliminate health disparities related to breast cancer in the United States and to increase the proportion of women who receive breast cancer screening based on the most recent guidelines. A step towards achieving these goals was made in the passing of the health care reform bill with the Patient Protection and Affordable Care Act (ACA) in 2010 which aims to improve insurance coverage and access to the healthcare system for every citizen of the United States [26]. However, a goal this immense is not likely to be achieved instantaneously and certain roadblocks are to be expected. Our study evaluated a free breast cancer screening program established in Lubbock, Texas. We aimed to show that free breast cancer screening clinics are successful at helping to achieve goals listed in Healthy People 2020. We hypothesized that women are more likely to return for subsequent screening mammograms after receiving a free screening mammogram and education. We hoped to shed light on the effectiveness of free breast cancer screenings and thus improve support and funding for these programs. Methods This retrospective review was approved by the Texas Tech University Health Sciences Center Institutional Review Board in Lubbock, Texas. Subjects were selected using a database collected by volunteering physicians during free breast cancer screenings paid for through a Cancer Prevention and Research Institute of Texas (CPRIT) grant, Susan G. Komen for the Cure grants, or private donations from September 2010 to February 2013. Inclusion criteria included women Journal of Cancer Diagnosis Puckett et al., J Cancer Diagn 2016, 1:1 Research Article Open Access Volume 1 • Issue 1 • 1000101 DOI: 10.4172/2476-2253.1000101 J Cancer Diagn, an open access journal ISSN:2476-2253 over 40 years of age with no previous history of breast cancer. A total of 523 patients met inclusion criteria. Qualifying women were followed for a minimum of 14 months to see whether a repeat screening mammogram was obtained. Screening mammogram was defined as a routine mammogram administered to detect breast cancer in women who have no apparent symptoms based on national screening guidelines. A diagnostic mammogram was defined as a mammogram that was obtained after suspicious results on a screening mammogram were found or after presentation of the patient with suspicious clinical signs such as a lump, breast pain, nipple discharge, thickening of the skin on breast tissue, or changes in the size or shape of breast. Compliance rate was defined as the number of all those studied who received a screening mammogram that subsequently returned within the following year to obtain an annual screening mammogram. Recall rate was defined as the number of screening mammograms that found an abnormality requiring further diagnostic imaging out of all screening mammograms obtained in the study. Cancer rate was defined as the number of cancers detected and confirmed in the study population per 1000 examinations. Baseline demographics such as employment status, insurance funding, race, total household income, language spoken, highest level of education, and months since previous mammogram were assessed. Information was collected on number of breast cancers detected, stage of cancer, time since last mammogram screening, whether this was patient’s first screening, and time to second screening. If cancer was detected, we investigated whether National Comprehensive Cancer Network (NCCN) guidelines were followed. Microsoft Excel was used to perform statistical analyses on continuous data. R Environment for Statistical Computing and Graphics (v3.0.2) was used to perform statistical tests and correlation analysis. A p-value of <0.05 was considered statistically significant. Volunteering physicians performed free physical exams and patient education. Results The mean age of women screened was 50.6, with a standard deviation (SD) of 6.9. Caucasian women comprised 41.5% of the population; Hispanic 41.1%, African-American 8.6%, and 8.8% were classified as other (Table 1). Demographics of Study Population