Facilitators for Access to Mammography and Characterization of Users. Breast Clinic, Northern Health Network ESE Cali 2023

Abstract

Introduction: Breast cancer is the most common cancer among women, especially in low- and middle-income countries, accounting for 45% of new cases and more than 55% of deaths. In Colombia, the incidence in 2020 was 15,509 cases (age-standardized rate: 48.3 per 100,000 women), with 4,411 deaths (age-standardized rate: 13.1 per 100,000 women). In Cali, breast cancer remains a public health priority, particularly among low-income women, with incidence rates increasing over the past two decades. Despite high health insurance coverage in Colombia, the use of mammography screening services is limited, reflecting systemic barriers and inequalities. This study aimed to identify the facilitators for accessing mammographic screening in women aged 50 to 69 who attend the Breast Clinic of the ESE Norte in Cali.
Methods: A mixed-methods design with a sequential explanatory approach was used. The quantitative component included a retrospective cross-sectional analysis of 2,859 mammograms performed in 2023, evaluating variables such as age, socioeconomic status, referral method, BI-RADS classification, and screening times. The qualitative component consisted of 28 in-depth interviews with women who completed the screening, analyzed using thematic network analysis.
Results: Quantitative findings showed that women aged 50–54 years had significantly greater access to timely mammograms (p = 0.04), as did residents of Commune 5 (p = 0.03). 98.6% of readings were performed within the standard timeframe, with an average of 3.3 days. Key facilitators identified qualitatively included medical recommendations and reminder systems, education on early detection, family and social support, an efficient screening process, modern equipment, and empathetic care from staff.
Discussion: The integration of administrative, clinical, and social strategies at the ESE Norte Breast Clinic has improved access to and adherence to mammographic screening. These results align with international literature highlighting the importance of social support, community outreach, and patient-centered services. The public nature of the program and its subsidized care also enhance accessibility for vulnerable populations.
Conclusions: This study highlights the effectiveness of a comprehensive approach to breast cancer screening. Strengthening these strategies can improve participation rates and health outcomes in resource-limited settings. Future research should explore the adaptability of this model in similar contexts.