The Breast Health Initiative

The Issue

 A 2004 study of newly diagnosed breast cancer cases showed that approximately 25 percent of the later-stage diagnoses were of uninsured women.

pcc_change_package_thumbnailThe earlier a cancer is detected, the sooner it can be treated, and the more likely it is that the patient will have a favorable health outcome. But low-income women in Montgomery County face many barriers when it comes to receiving regular cancer screenings.

In 2008 the mammography screening rate for low-income, uninsured women receiving primary care at safety-net clinics in Montgomery County was just 5.1 percent, far short of the national average of 71 percent. Culturally diverse low-income women face many barriers when trying to access care. Without health insurance and financial resources, many people put off preventive care and don’t go to see a doctor until their health has deteriorated, and those women who access care through safety-net clinics may face cultural barriers and other deterrents to receiving screening mammograms.

What We Did


The PCC launched the Breast Health Initiative in 2007, with support from a variety of funders including Susan G. Komen for the Cure, the American Breast Cancer Foundation, community partners providing in-kind services, and individual donors.

We started with a process improvement initiative in Montgomery County and in just a few years we were able to increase mammogram referral rates in pilot sites and reduce the length of time between referrals and screenings. Then, in 2010, we expanded the project to develop a regional learning collaborative and engage safety-net clinics throughout the National Capital Region.

With continued support from our funders we expanded our efforts again in 2012 with the Breast Health Quality Consortium, a four year project designed to improve the quality of breast health care throughout the National Capital Region, improving beyond the primary care provider and across the spectrum of breast health care by identifying and reducing disparities in service delivery.

We compiled our proven interventions in a Change Package which is now available as an online resource at

The Results

Through these efforts we have increased access to screening services for women receiving care at participating safety-net clinics.

Montgomery County Clinics

  • Referral rates: Increased from 8.7 percent to 47.4 percent
  • Screening rates: Increased from 5.2 percent  to 39.3 percent

Three Sites in Prince George’s County, the District, and Virginia

  • Referral rate: Improved from 49.5 percent to 60.6 percent
  • Screening rate: Improved from 27.1 percent to 41.7 percent
  • Cycle time from referral to screening: Improved from 48 days to 17.8 days, a 63 percent decline in average wait-time.
  • Volume/spread: From three sites to nine sites, targeting over 1,900 women.