Present: Melissa Leypoldt, Tamara Robinson, Melissa Baron, Jill Savage

AAWTF Key Influencers Workgroup Meeting, September 17, 2014

Prior to our meeting we reviewed the Breast Cancer Disparities among African American Women in Nebraska: Registry Data Analysis and Recommendations from August 2012 and the article “A community effort to reduce the black/white breast cancer mortality disparity in Chicago”.

Data
We have some key pieces of data that are specific to the African American women breast cancer population in Nebraska that provide sufficient evidence that this is an issue for our state as evidenced by the below sources:
Breast Cancer Disparities among African American Women in Nebraska: Registry Data Analysis and Recommendations from August 2012
Survival was significantly poorer among African Americans than among Caucasians. Five years after diagnosis, only 43% of African Americans were still alive, compared to 75% of Caucasians
Regardless of stage of cancer at diagnosis, African American women had poorer survival than Caucasian women (p<0.001).
African American women were significantly more likely than Caucasian women to be diagnosed at a late stage (regional or distant stage). Thirty-eight percent (38%) of African Americans were diagnosed at a late stage compared to 28% of Caucasian women. Later stage at diagnosis among African American women is related to lower frequency of and longer intervals between mammograms and lack of timely follow-up of suspicious results.
Compared to Caucasian women, those from racial and ethnic minority groups are more likely to have less frequent use of mammograms, longer intervals between mammograms, and less timely follow-up of suspicious results.
Cox proportional hazard regression analysis results show that African American race, older age, late diagnosis, and lower socioeconomic status were associated with poorer survival
We found that about 7 out of 10 (67.3%) African American patients lived in an area with very low or low socioeconomic indices, while only 3 out of 10 (32.1%) Caucasian women lived in areas designated as very low or low socioeconomic levels.
We found that 1 in 10 (9.3%) African American breast cancer patients were younger than 40 at the time of diagnosis. This finding underscores the importance of educating young African American women about breast cancer risk and the importance of screening.
Melissa Leypoldt shared data from BRFFS that shows a very low screening rate for mammograms in AA women in Nebraska

Melissa Leypoldt also shared data that shows the screening rate by EWM for program eligible African American women (23.8%) is almost equivalent to that for white women (24.6%)
Another possibility for collecting data is histology research using the Nebraska cancer registry to look at the frequency of screening and/or education about screening
Group also discussed if there would be a possibility of using cancer registry data to extrapolate patient outcomes or if they finished recommended treatment

CONCLUSIONS:
African American women in Nebraska have poorer survival as they are diagnosed at later stages of breast cancer, which is in turn due to lower frequency of and longer intervals between mammograms and lack of timely follow-up of suspicious results.
We know that there is a subset of AA women who are diagnosed before the age of 40, which underscores the importance of education and screening at a younger age
We need to find a way to educate AA women (including those below 40) on the importance of breast cancer screening.

We know the area where most of these patients reside and receive diagnosis and/or treatment
According to the Breast Cancer Disparities among African American Women in Nebraska: Registry Data Analysis and Recommendations from August 2012:
Most African American women resided in Douglas County (81%) or Lancaster County (8%) at the time of their diagnosis. Therefore, it is not surprising to find that many African American women were diagnosed and/or treated in Omaha health care systems, including the Alegent Health System (29%), The Nebraska Medical Center (27%), Creighton University Medical Center (21%), and Nebraska Methodist Hospital (10%)
Close to 80% of African American breast cancer patients are diagnosed or treated in the Alegent Health system, The Nebraska Medical Center or Creighton University Medical Center. Therefore, these 3 health care systems are in a unique position to spearhead efforts to improve the screening and detection of breast cancer and to deliver timely and high-quality treatment.
The group discussed that although we know where AA women are being diagnosed and treated, this is not the point in the continuum that we need to address
We also discussed that the population we are trying to reach (underinsured/uninsured) are generally being screened at FQHCs
There is a lot of work going on with the FQHCs with the Health HUBS that is targeting cancer screening (includes breast, cervical and colorectal)
Health HUBS are doing an internal and external scan which includes looking at their cancer screening rates and identifying gaps and needs to build capacity, access and improve health status
CONCLUSIONS:
Our geographical target area is Douglas and Lancaster County.
We should focus on AA women pre-screening
The best way to reach AA women pre-screening is through their community

The registry analysis puts forth the idea of a task force to identify partners and implement a pilot program
The Chicago study is all about their taskforce and identifies the partners they targeted and how they worked with them to gather the data they needed
The Taskforce explored three hypotheses: black women in Chicago receive fewer mammograms, black women receive mammograms of inferior quality, and black women have inadequate access to quality of treatment for breast cancer
They concluded that - There are significant access barriers to high quality mammography and treatment services that could be contributing to the mortality differences in Chicago. A metropolitan wide taskforce has been established to address the disparity.
The Taskforce concluded that the problem of breast cancer disparity in Chicago had many components but was primarily caused by gaps in education and access to screening and gaps in the quality of breast care across the continuum of care.
Recommendations by the Taskforce on remedies to the problem of black–white breast cancer mortality disparity address two overarching principles. The first was that no single entity in Chicago could ‘‘fix what was broken’’ and that this effort would thus require the participation of all institutions. Secondly, simply fixing one part of the breast health ‘‘system’’ would not be enough, all aspects had to be fixed together.
A number of studies have demonstrated that for diseases other than breast cancer, when the quality of care is measured, made transparent, and improved, the black/white disparity in various health care processes can be reduced or even eliminated.
Navigation programs have been shown to provide some reduction in delay time to treatment and reduce anxiety in women and have been recommended by the Taskforce
Who are the partners or “key influencers” that we are trying to identify?
CONCLUSION:
We identified that our key influencers or partners for reaching AA women pre-screening in their community includes schools, churches, and workplace.

ACTION ITEMS

Look for best practices or evidence based interventions with the AA populations for breast cancer screening education
RTIPS – Tamara
Previous Komen grants – Melissa Baron
Other ACS markets – Tamara
Research where AA women work
Douglas County labor statistics – Melissa Baron
Lancaster County labor statistics – Melissa Leypoldt
Work Well