Breast cancer screening practices of safety net clinics: Results of a needs assessment study

A needs assessment was conducted among eight community-based safety net clinics located in Montgomery County, Maryland to learn about breast cancer referral and screening procedures. Structured in-depth interviews were conducted with clinic staff during the summer of 2008.Safety net clinics reported that they routinely identified women who need mammography screening and referred women to mammography screening facilities. However, clinics were not aware of the limited number of free or low cost mammography screening slots available in the county or the waiting time to receive mammography services. Overall, screening barriers were common in the safety net system and only a few procedures were in place to help women overcome these barriers.Safety net clinics face multiple barriers in providing and coordinating breast cancer screening services for low income or uninsured patients. These barriers prevent the efficient allocation of mammography screening services and prevent underserved women from accessing an important preventive health service.Underserved women, which include both racial/ethnic minorities and the poor, have a greater chance of dying from breast cancer [1]. Widespread use of breast cancer screening has been found to be effective in reducing deaths from these cancers [2,3], yet underserved women are more likely to die from this disease [4,5]. These women are less likely to be screened [3,6], which results in later stage diagnosis and decreased survival rates [2,3,7].Barriers identified that contribute to low screening rates for breast cancer among underserved women suggest that there are both personal and health care factors that influence participation in screening [8]. Personal barriers include lack of awareness or knowledge about cancer screening, embarrassment in participating in actual screening procedures, low trust in prevention, and fear of cancer [9,10]. Additional personal barriers that prevent underserved women from participating in screening i