Long-term Mammography Utilization after an Initial Randomized Intervention Period by all Underserved Chilean Women in the Clinics

SIMPLE SUMMARY: Chile has one of the highest rates of breast cancer in Latin America. In Chile, underserved women have lower rates of mammography screening than their medium-to-high-level counterparts and higher morbidity and mortality rates of breast cancer. After a successful randomized controlled trial of low-socioeconomic-status women in a primary care clinic, we used the RE-AIM (Reach, Effectiveness, Adoption, Maintenance) framework to establish the long-term effects of that intervention. After ten years, women at the low-SES intervention clinic continued to show higher mammography rates compared to women at middle-SES clinics; further, these results continued to be above the national rates for low-socioeconomic-status peers. The RE-AIM framework indicates some of the factors that may have contributed to this successful long-term effect among marginalized women in Chile. ABSTRACT: Chile has one of the highest rates of breast cancer in Latin America. Mammography rates among women, especially those of low socioeconomic status (SES), are thought to contribute to high breast cancer morbidity and mortality. A successful randomized controlled trial among women aged 50 to 70 in a low-SES primary care clinic in Chile led to a significant increase in mammography screening rates in a two-year intervention trial. This study assesses the sustainability of the intervention after ten years and identifies factors that might have been associated with a long-term effect using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The mammography rates among women aged 50 to 70 in the low-SES intervention clinic were compared to two populations of women aged 50 to 70 from middle-SES clinics and to national data. Qualitative data were used to answer questions of adoption, implementation, and maintenance, while quantitative data assessed the reach and effectiveness. After ten years, low-SES women at the intervention clinic maintained significantly higher mammography screening rates vs. middle-SES women at the comparison clinics (36.2% vs. 30.1% and 19.4% p < 0.0001). Women of a low SES at the intervention clinic also had significantly higher screening rates compared to women of a low SES at a national level (44.2% vs. 34.2% p < 0.0001). RE-AIM factors contributed to understanding the long-term difference in rates. Mailed contact, outreach interventions, and the integration of health promoters as part of the Community Advisory Board were important factors associated with the effects observed. This study provides information on factors that could contribute to reducing the social gap on breast cancer screening.