Abstract PS1-13-26: Digital Self Service for Breast Cancer Screening: Early Experience with a Direct-to-Patient Program in a Federally Qualified Health Center

Abstract Background: Federally qualified health centers (FQHCs) serve lower income populations that have disproportionately low cancer screening rates; less than 50% of eligible women seen in FQHCs are up to date with mammograms. Additionally, many women at elevated breast cancer risk are unaware of their risk status, limiting access to genetic counseling and enhanced surveillance. Unfortunately, primary care providers report a lack of time to counsel women about screening and calculate individual risk scores. A digital health program delivered directly to patients outside the confines of a clinical visit could overcome many of these barriers. We evaluated a new “digital self-service” program for breast cancer screening in a pilot study in a FQHC in North Carolina. Methods: Each week, an automated query at the FQHC identified English or Spanish-speaking women aged 45 to 75 years who had no record of a screening mammogram in the prior 12 months and were scheduled for a primary care appointment in the next 9 to 16 days. The new digital health program, called mPATH-Breast, sent identified women an automated text message inviting them to determine their personal risk for breast cancer by clicking a hyperlink that launched the mPATH-Breast web app. The web app, available in English and Spanish, included a landing page informing women of the importance of breast cancer screening, allowed women to estimate their personal lifetime risk using the Gail model, confirmed they were due for routine screening, displayed a brief animated decision aid video, and allowed them to request either a mammogram or a referral to a high risk breast clinic as appropriate based on their risk score. mPATH-Breast then automatically transmitted mammogram and referral requests to the FQHC scheduling team and generated a one-page summary of each patient’s app use for upload into the electronic health record (EHR). Results: Between June 2025 and August 2025, the mPATH-Breast program sent text message invitations to 207 women, of which 193 (93%) were successfully delivered. Of the 193 women reached, 47 (24%) clicked the embedded hyperlink, and 17 of the 47 (36%) started the mPATH-Breast program. Fifteen of those 17 women (88%) completed the entire program. All 15 women (100%) elected to estimate their personal risk for breast cancer, with lifetime risks ranging from 3.2% - 9.8%. Nine of the 15 women (60%) reported having a mammogram in the last 12 months, and 4 women (27%) were confirmed due for average-risk mammography, of whom all 4 (100%) requested a mammogram. Conclusion: This early pilot demonstrates that a direct-to-patient digital program can effectively engage women in FQHC settings, where mammography uptake is otherwise low. Nearly all women who started the program completed it and chose to estimate their personal breast cancer risk; every woman found to be overdue requested a mammogram. Notably, more than half of women reported having a recent mammogram that was not documented in the EHR, underscoring the common challenges of capturing screening completed outside the health center and the importance of accurate record integration. Taken together, these results show that a direct-to-patient digital program can improve risk awareness, drive immediate action, and offer a scalable, patient-centered strategy to strengthen breast cancer prevention and early detection in underserved populations. Future research should examine strategies for increasing patient engagement with digital tools for screening. Citation Format: E. Hultgren, D. Smith, D. Santillan, D. P. Miller, L. Alexander. Digital Self Service for Breast Cancer Screening: Early Experience with a Direct-to-Patient Program in a Federally Qualified Health Center [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-13-26.