title: Joint breast and colorectal cancer   screenings in medically underserved   women.
abstract: BACKGROUND
  Breast and colon cancer screening in rural community clinics is underused.
  
  
  OBJECTIVE
  To evaluate the effectiveness and cost-effectiveness of alternative interventions designed to promote simultaneous screening for breast and colon cancer in community clinics.
  
  
  METHODS
  A 3-arm, quasi-experimental evaluation was conducted during May 2008-August 2011 in 8 federally qualified health clinics in predominately rural Louisiana. Baseline screening rates reported by the clinics was <10% for breast cancer (using mammography) and 1%-2% for colon cancer (using the fecal occult blood test [FOBT]). 744 women aged 50 years or older who were eligible for routine mammography and an FOBT were recruited. The combined screening efforts included: enhanced care; health literacy-informed education (education alone), or health literacy-informed education with nurse support (nurse support).
  
  
  RESULTS
  Postintervention screening rates for completing both tests were 28.1% with enhanced care, 23.7% with education alone, and 38.7% with nurse support. After adjusting for age, race, and literacy, patients who received nurse support were 2.21 times more likely to complete both screenings than were those who received the education alone (95% confidence interval [CI], 1.12-4.38; P = .023). The incremental cost per additional woman completing both screenings was $3,987 for education with nurse support over education alone, and $5,987 over enhanced care.
  
  
  CONCLUSIONS
  There were differences between the 3 arms in sociodemographic characteristics, literacy, and previous screening history. Not all variables that were significantly different between arms were adjusted for, therefore adjustments for key variables (age, race, literacy) were made in statistical analyses. Other limitations related generalizability of results.
  
  
  CONCLUSIONS
  Although joint breast and colon cancer screening rates were increased substantially over existing baseline rates in all 3 arms, the completion rate for both tests was modest. Nurse support and telephone follow-up were most effective. However, it is not likely to be cost effective or affordable in clinics with limited resources.
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Connie L
authors.initials: CL
authors.lastname: Arnold
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bennett
authors.forename: Dachao
authors.initials: D
authors.lastname: Liu
authors.forename: Alfred
authors.initials: A
authors.lastname: Rademaker