Latina women in the United States nearly doubled their rate of screening for breast cancer after visits from a health-promoting promotora. Although 11% of women who did not receive such at-home visits still underwent mammography to screen for breast cancer, more than 19% of women who received these visits later underwent mammography.1
Among American women, breast cancer is the most common type of cancer. Hispanic women are more likely than non-Hispanic white women with breast cancer to have later stage disease at diagnosis. Furthermore, breast cancer is the most common cause of cancer death among American Hispanic women. A promotora is a lay health worker who provides specialized education in the community without having professional training as a health worker. Promotoras are typically bilingual and bicultural, and must have good communication skills.
The ¡Fortaleza Latina! program, or Latina strength, recruited 536 Hispanic women from 4 Sea Mar Community Health Clinics in the Seattle, Washington, area. Participants’ ages were 42 to 74 years. These women had attended a primary care appointment in the previous 5 years but had not had mammography in the previous 2 years.
Participants completed surveys when the study began in 2011 and again when the study ended in 2014. Electronic medical records verified whether women had received a mammography. The majority of participants (80%) were born in Mexico, and 92% preferred speaking Spanish. Most had completed less than 8 years of formal education and earned less than $20 000 per year. Almost three-quarters did not have health insurance.
The 536 women were randomly assigned to receive a visit from a promotora or to receive their usual care. Promotoras were women who received a minimum of 3 days of training in motivational interviewing and in health information and mammography importance. Visits were conducted at home.
Nearly twice as many women (19%) who received promotora visits underwent mammography, while 11% of women who did not receive promotora visits underwent mammography (P < .01). While 2 clinics had mobile mammography vans, the vans did not increase screening rates. Most community clinics relied on wheeled-in mammography units.
The authors emphasized the importance of peer-to-peer community visits to increase screening for breast cancer and to reduce health disparities.
“Promotora visits are essential in educating Latina women about the importance of breast cancer screening,” stated Gloria Coronado, PhD, cancer disparities researcher at the Kaiser Permanente Center for Health Research in Portland, Oregon, and first author of the study.
“Our study showed a modest, but significant increase in screening rates. We are encouraged by these findings, and must continue to involve patients, clinics and communities in efforts to further reduce the inequity in breast cancer screening.”
1. Coronado GD, Beresford SA, McLerran D, et al. Multilevel intervention raises Latina participation in mammography screening: findings from ¡Fortaleza Latina! [published online ahead of print April 2016]. Cancer Epidemiol Biomarkers Prev. doi:10.1158/1055-9965.EPI-15-1246.