Mobile Mammography Unit Increases Breast Cancer Screening Among Latina Patients

Patrick J. Dineen, MD, MBA | Image Credit: Stony Brook University Hospital Cancer Center

Since the July 29, 2018, delivery of its ADA-accessible mobile mammography unit, affectionately named Pinky, Stony Brook University Hospital Cancer Center has seen a 666% percent increase in breast cancer screenings among the predominantly Latina population that it serves on Long Island: from 9% at its breast center to 69% with the mobile unit. On its first and second days of site visits alone, September 27-28, 2018, breast cancer was identified in 2 women.

Patrick J. Dineen, MD, MBA, manager of cancer prevention and screening, Stony Brook University Hospital Cancer Center, presented the results that Pinky has been able to achieve thus far at this year’s Association of Community Cancer Centers 40th National Oncology Conference held October 4-6, 2023, in Austin, Texas, in the session, “Get Screened: No Excuses!”

“Breast cancer specifically has an extremely high rate of incidence and mortality still, even though screening is readily available,” Dineen emphasized. “And this is one particular example.”

To date, more than 7000 women have received a breast cancer screening through Pinky, which has a fully equipped hospital exam room, a changing room, a 3-D mammography unit, and an intake area for patients to check in with staff.

“Basically everything that's available if you walk into a brick-and-mortar facility yourself, except when you walk into this mobile clinic, there's only 1 patient at a time, so you're getting individualized attention and care,” he added, “which increases the value in the patient’s heart that they are receiving this treatment from us and that the staff care so deeply about.”

There have also been more than 400 Breast Imaging Reporting and Data System (BI-RADS) categories with recommended follow-up, 40 diagnosed cancers, and over 270 Uber rides funded and provided, which has helped to reduce late arrivals and increase total patients who book and present to their appointments.

Why Uber rides? “Because barriers to health care still exist,” Dineen noted. “Even if you remove some of them or all of them, and even though you are removing them, your patients might not know that they are removed.”

The multipronged approach that Pinky incorporates uses both mobile- and office-specific staff, physicians who are cross-trained, and a majority of staff who are bilingual, “so they speak the language that many of the community members who we serve, speak,” Dineen explained.

Screening locations are local businesses, fire houses, libraries and school districts, churches, senior centers, media/public relations, and federally qualified health centers (FQHCs), and patients do not have to have a history with the Stony Brook medical system. To be eligible for a breast cancer screening with Pinky, prospective patients have to be 40 years or older—50% are aged 40 to 49 years, 37% are aged 50 to 64 years, and 13% are 65 years or older; cannot have had a mammogram in the past year, be pregnant, or have acute breast pain/issues; and can be insured (their physician has to accept the mammogram results) or uninsured. Recent data show that 58% of patients served by Pinky are uninsured.

Two major community partners help Pinky to break down barriers that prevent equitable health outcomes, such as financial toxicity and transportation. Cancer Services Program, from the New York State Department of Health, helps to cover the costs of many screenings for uninsured and underinsured patients: breast cancer (mammograms and clinical breast exams), cervical cancer (PAP and HPV exams), and colorectal cancer (fecal immunochemical test kits). Pink Aid provides an annual grant to the Stony Brook mobile unit that funds the Uber rides for patients.

Dineen explained that uninsured women are more likely to delay cancer screenings, leading to more expensive and advanced cancer stages, so these community partnerships are invaluable.

The first full year of operation, 2019, saw 1509 screening mammograms, but during the COVID-19 pandemic, screenings dropped to 1196 in 2020 and 1085 in 2021. There was a slight uptick to 1512 in 2022, and the projected screening total for 2023 is 1884, representing a 25% jump from 2019.

A self-evaluation project conducted in partnership with Harvard Medical School aimed to quantify the impact of the mobile mammography unit on the Hispanic population in the 17 most underserved ZIP codes in Suffolk County (the larger of Long Island’s 2 counties; the other being Nassau County) that were identified through a community needs assessment. A screening capacity was set at 70%, “because data show that the high end of women screened on Long Island of the Hispanic population, the ceiling will be 70%, not 100%,” Dineen explained.

Results show that even in areas with an FHQC, which were Riverhead, Greenport, Shirley, Patchogue, Amityville, and Brentwood, the Latina population in those ZIP codes still noticeably utilized Pinky for mobile breast cancer screenings, at approximate rates of 58%, 42%, 39%, 37%, 20%, and 10%.

When the investigators considered that each of the 26 hospitals in those 17 ZIP codes and the mobile unit from Stony Brook had an equal share of the Hispanic population being screened, they landed at 3.8%. In reality, Dineen noted, the actual market share that the mobile unit serves is 15% of the total Hispanic population in those 17 ZIP codes.

A comparison of breast cancer screenings between brick-and-mortar breast centers and the mobile mammography unit showed that minority women overwhelmingly preferred the latter for their screenings. From 2019 through 2023, more Indian, Asian, Black, and Hispanic women underwent mobile breast cancer screenings instead of heading to a brick-and-mortar location, respectively, compared with White women:

• Indian: 1% vs 0%
• Asian: 2.8% vs 1.0%
• Black: 6.7% vs 4.1%
• Hispanic: 67.7% vs 4.4%
• White: 21.9% vs 85.6%

In addition, when comparing the total minority population screened through Pinky vs Stony Brook’s 4 other mammography facilities, nearly 80% chose to get a screening through the mobile unit. No more than 10% were screened at any of the other facilities.

“Trust is not built overnight, and trust is not guaranteed, especially if you're trying to screen underserved women who don't speak English in communities that are not bringing themselves to your hospital or to any health care system,” Dineen emphasized. “It’s all about bringing health equity home and building trust in underserved communities in order to increase access to health care services, like cancer screenings. We must consistently show up in communities and provide care through initiatives, like the mobile mammography unit.”

Reference

Dineen PJ. Get screened: no excuses! How we improve health equity to delivery accessible care to underserved communities. Presented at: Association of Community Cancer Centers 40th National Oncology Conference; October 4-6, 2023; Austin, TX.