Health Policy and Health Services: Serving Women's Needs

If research findings are going to lead to action and change, then gathering important information for policy makers at the national, state, and local level is vital. Research in this area is aimed at developing strategies to serve women more effectively by investigating the organizational and sociopolitical context of breast cancer prevention, detection, and treatment.

The CBCRP funds research aimed at making the health care system more responsive to the needs of women with breast cancer and better at preventing the disease. We're looking for ways to reduce waste and increase access to breast cancer care, and we encourage research on actions that will reduce inequalities in access to prevention and treatment among California's geographically and ethnically diverse population. The CBCRP encourages more research in the health policy and health services area.

Samoans and Breast Cancer: Evaluating a Theory-Based Program. Samoan American women have a high incidence of breast cancer, a low awareness of the disease, and a low rate of use of early-detection services. Shiraz I. Mishra, Ph.D., at the University of California, Irvine, and Pat H. Luce-Aoelua, M.S., at the National Office of Samoan Affairs, Carson, implemented and evaluated an innovative, theory-based, culturally sensitive, and linguistically appropriate breast cancer control educational program for Samoan American women. The goals were to enhance breast cancer awareness, increase the rate at which Samoan American women get mammograms, and over time, potentially lower breast cancer incidence and deaths in this marginalized community. The education program included specially developed English and Samoan-language educational materials, skills building exercises, and interactive group discussions. The research surveyed 776 women of Samoan heritage, age 42 or over, who had not had a mammogram within two years or longer, or who had never had one. There were 391 women who received the educational intervention and 389 who did not. Results of this study indicated that over 58% of the women participating in the study had never had a mammogram. Those more likely to never have had a mammogram were more likely to be older, less educated, uninsured, unemployed, with less than $10,000 per year in family income, and interviewed in Samoan. Women were more likely to have had a mammogram if they had positive group norms for obtaining one, health insurance, positive belief in the effectiveness of mammograms, fewer misconceptions about the cause of breast cancer, fewer culture-specific beliefs about the causes of breast cancer, and higher self-efficacy. Analyses to assess the efficacy of the intervention are in progress.

Research in Progress

Does a Peer Navigator Improve Quality of Life at Diagnosis? David Spiegel, M.D., of Stanford University, is collaborating with Caroline Bliss- Isberg, Ph.D., of the community organization WomenCARE, in Santa Cruz, in a pilot study to gather data in order to conduct a larger study. The goal is to evaluate the effectiveness of matching women who have just learned they have breast cancer with trained volunteer beast cancer survivors (peer navigators). Each navigator and woman with cancer make at least one contact a week for three months. The relationships can be renewed by mutual agreement every three months. This study addresses the needs of women newly diagnosed with breast cancer at the time when they say they have the greatest need for counseling. Many women don't seek formal counseling services because they feel overwhelmed, are unfamiliar with available resources, or are concerned about stigma in seeking counseling. The Peer Navigator Program provides emotional support, peer modeling, survival modeling, and information on resources for women who have just been diagnosed with breast cancer. In this preliminary study, the research team has matched 37 newly-diagnosed women with peer navigators. The team has extensively promoted the program within the local medical community, so that women are sometimes referred by medical professionals within 1—2 days of diagnosis.

Race/Ethnicity, Socioeconomic Status and Breast Cancer. William Wright, Ph.D., at the Public Health Institute, Berkeley, is investigating the relationship between race/ethnicity and socioeconomic status in the risk of developing breast cancer. Women in California from different ethnic groups or socioeconomic levels are not equally affected by breast cancer. Dr. Wright is using innovative statistical methods to analyze data from California's statewide cancer registry and the Women's Health Survey, a 1998 survey of 4,000 California women from various ethnic groups. He is trying to determine whether the relationship between socioeconomic status and stage of diagnosis for breast cancer varies among ethnic groups. So far, he has found that Asian/other women with higher socioeconomic status are more likely to have their disease diagnosed at the earliest in situ stage, when the changes in the breast are still pre-cancerous. Hispanic women with higher socioeconomic status are more likely to have their breast cancer diagnosed at an early stage. Women in both ethnic groups with lower socioeconomic status are more likely to be diagnosed with cancer at later stages. Socioeconomic status itself is not a risk factor for breast cancer stage at diagnosis. Women with high socioeconomic status were more likely to have had a mammogram or clinical breast exam. Dr. Wright has also shown that due to the way race data were collected on the 2000 US Census, the California Cancer Registry won't be able to calculate breast cancer rates by ethnic group in 2000 and beyond, or monitor trends in breast cancer by ethnicity.

Research Initiated in 2001