Screening Beyond Breast Cancer: Identifying Quality Gaps in Breast Cancer and Cardiovascular Health Literacy in Women in Underserved Communities

Purpose: Breast cancer screening initiatives such as mobile mammography units (MMUs) reduce adverse health outcomes within underserved communities. However, these populations experience a high burden of comorbid cardiovascular disease (CVD). This study aims to identify gaps in breast cancer and CVD health literacy among women from underserved communities compared with women receiving care at hospital-based mammography clinics in order to guide future quality improvement health education initiatives delivered at MMUs, reducing overall disease burden.

Methods/Materials: A standardized, anonymous survey was administered between 2022-2024 to two groups: a) women attending a community-based cancer awareness walks in an underserved area and b) women undergoing screening mammography at a hospital radiology clinic. The survey assessed knowledge of breast cancer and CVD risk factors, causes of morbidity, and interest in receiving education on CVD risk reduction. Descriptive statistics and two-sided z-tests compared responses.

Results: A total of 736 surveys (community: 49.3%; clinic: 50.7%) identified significant differences in health literacy. Only 29.8% of community participants identified CVD as the leading cause of death amongst women, compared to 60.1% of clinic participants (p-value < 0.001). Fewer community participants identified mammography as the most appropriate breast cancer screening modality (43.5% vs. 70.2%, p < 0.001). Knowledge of lifetime breast cancer risk was lower in community participants (43.0% vs. 53.4%, p < 0.01). Interest in CVD prevention education during screening visits was higher among community participants (45.2% vs. 36.5%, p = 0.02).

Conclusions: Women surveyed at community-based initiatives demonstrated significantly lower breast cancer and CVD health literacy than women receiving care at hospital mammography clinics, representing a measurable quality gap in preventative health knowledge. Increased interest in CVD education among community participants highlights an opportunity to enhance screening mammography encounters with quality interventions that address CVD health education, reducing overall morbidity and mortality in women from underserved communities.