Identifying Structural Barriers to Breast Cancer Screening Within 10 Neighborhoods Noted as Having Elevated Levels of Late-Stage Breast Cancer Diagnoses in Allegheny County: A Community-Based Approach

Introduction: Despite high rates of mammography among women over 40, the Allegheny County Health Department has identified 10 neighborhoods as having higher-than-expected rates of late-stage breast cancer diagnoses. Considering the sociodemographic and socioeconomic contexts of each neighborhood, stakeholders from local healthcare, faith-based, and non-profit organizations were interviewed regarding their perception of breast cancer and healthcare accessibility within their communities to better understand and potentially identify what structural or system-level barriers may be preventing women from getting screened at an earlier stage in the development of their breast cancer. Methods: Socio-demographic and -economic data on the 10 neighborhoods were collected and later analyzed using SAS software to identify potential patterns or commonalities across communities. Community resources were identified within each neighborhood and engaged through cold calls, emails, and in-person visits. Brief interviews were then conducted among breast health experts and individuals with either personal or professional experience in the realm of breast cancer and community health provisions; responses were later categorized and thematically coded to determine the commonality of public opinions and concerns regarding breast cancer prevalence, local impact, community health needs and strengths, as well as overall healthcare accessibility. Results: The results of both unadjusted and adjusted multivariable logistic regressions indicated no significant association between selected socio-economic factors and the SIR of late-stage breast cancer, indicating other structural barriers at play. Regarding interview responses, as identified by key community stakeholders, the most prominent barriers to breast health within these neighborhoods were insurance coverage, transportation, and fear/mistrust in the healthcare system. Racial discrimination, cost of care, and inaccessibility of services were also highlighted by interviewees as being significant obstacles to timely breast cancer screening. Discussion: Regardless of neighborhoods’ demographic and economic diversity, community health concerns were quite similar across neighborhoods, expressing an overarching interest in breast cancer-related programming that focuses on on-demand assistance and individualized support. Aiming to strengthen breast cancer-related healthcare accessibility for women across Allegheny County, the public health significance of this work lies in both reducing the incidence and improving outcomes of late-stage breast cancer in the neighborhoods and communities most impacted by breast cancer.