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1.  Strategies for Increasing Mammography Screening in Primary Care in Chile: Results of a Randomized Clinical Trial 
Background
Breast cancer is the cancer with the highest incidence among women in Chile and in many Latin American countries. Breast cancer screening has very low compliance among Chilean women.
Methods
We compare the effects on mammography screening rates of standard care, of a low intensity intervention based on mail contact, and of a high intensity intervention based on mail plus telephone or personal contact. A random sample of 500 women 50 to 70 years registered at a community clinic in Santiago who had not had a mammogram in the past two years were randomly assigned to one of the three intervention groups. Six months after randomization, participants were re-evaluated for their compliance with mammography screening. The outcome was measured by self report and by electronic clinical records. An intention to treat model was used to analyze the results.
Results
Between 92% and 93% of participants completed the study. Based on electronic records, mammography screening rates increased significantly from 6% in the control group to 51.8% in the low intensity group, and 70.1% in the high intensity group. About 14% of participants in each group received opportunistic advice, 100% of participants in the low and high intensity groups received the mail contact, and 50% in the high intensity group received a telephone or personal contact.
Conclusion
A primary care intervention based on mail or brief personal contact could significantly improve mammogram screening rates.
Impact
A relatively simple intervention could have a strong impact in breast cancer prevention in underserved communities.
doi:10.1158/1055-9965.EPI-10-0313
PMCID: PMC3985495  PMID: 20826832
2.  Perceived and objective breast cancer risk assessment in Chilean women living in an underserved area 
Background
Breast cancer is the most frequently diagnosed malignancy among Chilean women and an increasingly significant public health threat. This study assessed the accuracy of breast cancer risk perception among underserved, Chilean women.
Methods
Women aged 50 to 70 years, with no mammogram during the last two years, were randomly selected from a community clinic registry in Santiago, Chile (n=500). Perceived risk was measured using three methods: absolute risk, comparative risk and numerical risk. Risk comprehension was measured by comparing women’s perceived and objective risk estimates. Multivariate logistic regression was used to assess overestimation of perceived risk.
Results
Women at high risk of breast cancer were more likely than average risk women to perceive themselves at high or higher risk, using absolute and comparative risk approaches (p<0.001). The majority of participants (67%) overestimated their breast cancer risk, based on risk comprehension; although, participants achieved higher accuracy with comparative risk (40%) and absolute risk (31.6%) methods. [Age, breast cancer knowledge and Breast Cancer Risk Assessment Tool (BCRAT) 5-year risk were significantly associated (p<0.01) with accuracy of perceived risk].
Conclusion
Chilean women residing in an underserved community may not accurately assess their breast cancer risk, though risk perception and level of accuracy differed between perceived risk measures. Comparative and absolute risk methods may better reflect women’s interpretation and accuracy of risk perception.
Impact
Improving our understanding of Chilean women’s perceptions of developing breast cancer may lead to the development of culturally relevant efforts to reduce the breast cancer burden in this population.
doi:10.1158/1055-9965.EPI-12-0242
PMCID: PMC3467315  PMID: 22837144
Hispanic; Latina; Breast Cancer; Risk perception; Risk comprehension
3.  Cervical cancer screening and adherence to follow-up among Hispanic women study protocol: a randomized controlled trial to increase the uptake of cervical cancer screening in Hispanic women 
BMC Cancer  2012;12:170.
Background
In the US, Hispanic women have a higher incidence of, and mortality from, cervical cancer than non-Hispanic white women. The reason for this disparity may be attributable to both low rates of screening and poor adherence to recommended diagnostic follow-up after an abnormal Pap test. The 'Cervical Cancer Screening and Adherence to Follow-up Among Hispanic Women' study is a collaboration between a research institution and community partners made up of members from community based organizations, the Yakima Valley Farm Workers Clinic and the Breast, Cervical, and Colon Health Program of the Yakima District . The study will assess the efficacy of two culturally-appropriate, tailored educational programs designed to increase cervical cancer screening among Hispanic women, based in the Yakima Valley, Washington, US.
Methods/design
A parallel randomized-controlled trial of 600 Hispanic women aged 21–64, who are non-compliant with Papanicolau (Pap) test screening guidelines. Participants will be randomized using block randomization to (1) a control arm (usual care); (2) a low-intensity information program, consisting of a Spanish-language video that educates women on the importance of cervical cancer screening; or (3) a high-intensity program consisting of the video plus a ‘promotora’ or lay-community health educator-led, home based intervention to encourage cervical cancer screening. Participants who attend cervical cancer screening, and receive a diagnosis of an abnormal Pap test will be assigned to a patient navigator who will provide support and information to promote adherence to follow-up tests, and any necessary surgery or treatment. Primary endpoint: Participants will be tracked via medical record review at community-based clinics, to identify women who have had a Pap test within 7 months of baseline assessment. Medical record reviewers will be blinded to randomization arm. Secondary endpoint: An evaluation of the patient navigator program as a method to improve adherence and reduce time to follow-up among participants who receive an abnormal Pap test result. An additional secondary endpoint is the cost-effectiveness of the two different intensity intervention programs.
Discussion
This culturally sensitive intervention aims to increase compliance and adherence to cervical screening in a Hispanic population. If effective, such interventions may reduce incidence of cervical cancer.
Trial registration
NCT01525433
doi:10.1186/1471-2407-12-170
PMCID: PMC3407514  PMID: 22559251
Hispanic women; Pap test; Cervical cancer screening; Cancer disparities

Results 1-3 (3)