This study proposes to use two approaches to increase breast and cervical cancer screening rates among women who are predominantly indigent, elderly and/or Native American 40 years of age and older by: 1)promotion of cancer screening within a major county hospital to women who present for reasons other than cancer screening (""""""""inreach""""""""); and 2) encouragement and mobilization of women from within the community who live in low income high-rises to be screened (""""""""outreach""""""""). Based on formative research and pilot studies conducted in the first year, the hospital-based intervention will develop and implement strategies to improve the proportion of poor and Native American women who are offered, accept, and complete breast and cervical cancer screening. The efficacy of standing orders for screening, a freestanding screening clinic, recruitment from clinics other than primar care, and the offer of immediate (rather than scheduled) screening will be studied. One thousand five hundred women from the general hospital population plus 250 additional Native American women will be randomized to either a breast and cervical cancer screening intervention (based on the formative research) or usual care (control). Cost-effectiveness will be assessed and hospital staff will be trained to help sustain the activity. The outreach component will use a commumity organization and reconnaissance approach to promote breast cancer screening to poor and elderly women who live in low income high-rises. Forty-two high-rise buildings will be randomized to be either treatment or control conditions. In the treatment condition, social workers and peer leaders from the high-rises will encourage their clients and neighbors to be screened during annual 12 week campaigns. Screening rates will be assessed by self-report to be confirmed by a database the Minnesota Department of Human Services maintains for all paid procedures for Medicaid patients. The American Cancer Society will assist during the first two intervention years and take over the campaign during the last phase of the outreach component of this study.
