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African American/Black women die of breast cancer more often than their White counterparts (27.6 compared with 19.8 per 100,000).1 In certain states, including Tennessee, while the incidence of new breast cancer is similar between White and African American/Black women (122.3 vs. 123.6 per 100,000), the number of deaths per 100,000 African American/Black women is higher, than that of White women (29.8 versus 20.5 per 100,000), suggesting that African American/Black women are being diagnosed at later stages.1 Breast cancer screening is an effective method for identifying cancer in its early stages, and can result in better outcomes and mortality rates. However, research has shown that African American/Black women are less likely to be screened for breast cancer in some communities – including Tennessee. An analysis of Cigna's breast cancer screening rates found significantly lower screening rates among African American/Black customers in comparison to White customers.
Cigna sought to increase screening rates among African American/Black women in the state of Tennessee, which has a very diverse population. Even though we saw significant improvements across the state, we decided to make a concerted effort to focus on the greater Memphis area (Shelby County). We did this in conjunction with the Health Equity Team at Cigna and a local health system because there is a large concentration of customers in that area who have limited access to screening facilities. The objective of the campaign was to reduce the disparity in screening rates between African American/Black and White customers within the state, and within Shelby County in particular. In year one, the campaign focused on unscreened African American/Black women statewide, while in year two the campaign narrowed the focus on Shelby County. Finally, in year three, the campaign was further narrowed to those customers in neighborhoods where access to screening facilities was limited.
Cigna focused on engaging customers to obtain screening through multiple innovative initiatives, including culturally tailored messaging and imagery, segmentation messaging tailored to individual personas, personalized location listing of screening facilities nearest to the customer’s home, and personalized mobile mammography events in the customer’s neighborhood.
The initiatives occurred from 2012 through 2017. Cigna measured improvement each year and found statistically significant improvement year over year. The end result of this multi-year, multi-modal approach resulted in the breast cancer screening disparity between African American/Black and White customers, originally identified in 2012 data, being eliminated in both Shelby County and Tennessee as a whole. In 2020, buoyed by the promising results in Tennessee, Cigna launched a national initiative to increase screening rates among African American/Black women.
1U.S. Cancer Statistics Working Group. U.S. Cancer Statistics Data Visualizations Tool, based on 2019 submission data (1999 - 2017): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; www.cdc.gov/cancer/dataviz, released in June 2020.