Efficacy of a Community Program in Increasing Access to STAR

Institution: University of California, Los Angeles
Investigator(s): Patricia Ganz, M.D. - Kathleen Brown, M.D. -
Award Cycle: 2001 (Cycle VII) Grant #: 7AB-1300 Award: $68,350
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

This is a collaboration with: 7AB-1301 -

Initial Award Abstract (2001)
Breast cancer is the leading type of cancer in African American women. Despite the lower rate of cancer in African American women, the mortality rate is higher than in other ethnic groups. Although the reasons for the difference is not entirely known, contributory factors may include diagnosis at a later stage of disease and a possible difference in the manner the tumors behaves and responds to therapy. Community outreach efforts to improve survival have focused on improving the early detection of cancer through breast self-examination (BSE), clinical breast examination (CBE) and screening mammography.

Although early detection of breast cancer is crucial to improved survival, prevention of cancer through a variety of interventions holds tremendous promise. The enrollment of African American women in chemopreventive clinical trials has been less than optimal, however. Given the potential variability in response to a therapeutic or preventive protocol, greater enrollment of minorities in clinical trials is needed.

The Association of Black Women Physicians and the Division of Cancer Prevention and Control Research at the School of Public Health and Jonsson Comprehensive Cancer Center at UCLA propose to collaborate in the development of methods to increase the awareness of African American physicians and community women about breast cancer chemoprevention and clinical trials. The long-term goal of this CRC pilot study will be to test this approach in a randomized trial to lead to increased participation in chemoprevention clinical trials.


Final Report (2005)
The principal goal of the CRC pilot study was to design and pilot test intervention materials to enhance the knowledge, attitudes and behavior surrounding participation in breast cancer chemoprevention trials among African American physicians and African American women from the community. Project activities targeted two specific groups: health care providers who are members of the Association of Black Women Physicians (ABWP) and community women who are served by the ABWP “Second Sundays” breast health education program. During the course of the study we completed all of our proposed aims.

To better understand provider knowledge and beliefs about chemoprevention trials and develop education materials for providers, we conducted key informant interviews, focus groups and completed a survey by mail with members of the ABWP. From this work, we have identified common barriers to physician recommendation of clinical trials including: risk of investigational therapeutic agent, the difficulty in scheduling time to discuss prevention with patients, lack of familiarity with research trials that are available, lack of time to discuss research trials with patients, lack of knowledge of eligibility, patient distrust of doctors and medical research, and the failure of other trials to disseminate results back to the community.

From the community viewpoint, issues raised included the need for more information about medical trials, need for African American investigators to be involved in the trials, fear of medication and side effects, distrust of research (including the Tuskegee trials) and time constraints.

The results of these activities were used to develop and deliver an educational Continuing Medical Education program to ABWP providers in April 2002. We helped the ABWP develop an educational presentation on breast cancer chemoprevention that ABWP providers delivered to African American women in the community through their “Second Sundays” program. Over 150 women in the community were reached through this pilot program.


Symposium Abstract (2003)
This project is a collaborative effort between members of the Association of Black Women Physicians (ABWP) and researchers at the UCLA Division of Cancer Prevention and Control Research. The principal goal of the study is to design and pilot test intervention materials that will enhance the knowledge, attitudes and behavior surrounding participation in breast cancer chemoprevention trials among African American physicians and African American women from the community. Project activities target two specific groups: health care providers who are members of the ABWP and community women who are served by the ABWP “Second Sundays” Breast Health Education Program.

To better understand provider knowledge and beliefs about chemoprevention trials, we conducted key informant interviews and focus groups with members of the ABWP. Based on these activities and data from the literature, we developed and conducted a mailed survey of members of the ABWP. The survey was completed in September 2002, with a 59% response rate (N=87). From this work, we identified common barriers to recommendation including the difficulty in scheduling time to discuss prevention with patients, lack of familiarity with research trials that are available, patient distrust of doctors and medical research, and the failure of other trials to disseminate results back to the community. A Continuing Medical Education program was presented to ABWP providers, which included an educational component about breast cancer chemoprevention and clinical trials, followed by a presentation of the preliminary results from the ABWP survey and a panel discussion lead by ABWP members on strategies to incorporate discussions of prevention and clinical trials in practice.

The other focus of the pilot project was to develop an educational presentation on breast cancer chemoprevention for African American community women. To this end, we conducted focus groups with African American women from community churches to better understand community beliefs and barriers to participation in clinical trials. An educational module on breast cancer chemoprevention was developed and has been presented as part of the ABWP “Second Sundays” Breast Health Educational Program for community churches. Although this segment of the project is still underway, evaluations thus have been positive with 94 % of respondents finding the program very useful and 72% of respondents stating they would now consider participating in a medical research study (N=62). Completion of the project is anticipated in December 2003, with additional educational programs scheduled for community women.