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Published on: May 17, 2019
Assessing the Utility of the Community Need Priority Index for Breast Cancer Screening
David N Karp1,2, Khaldoun Hamade2,3, Christopher M McNair2,3
1Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA.
Purpose:
Cancer centers are required to facilitate interventions that engage communities in reducing the cancer burden in their catchment area. Tools exist to visualize catchment area data, but none integrate multiple factors for targeting interventions. The Community Need Priority Index-Breast Cancer Screening (CNPI-BCS) was created to approximate population-level need on the basis of characteristics associated with low adherence to routine screening guidelines. This study demonstrates program-specific utility of CNPI-BCS, by describing alignment between the index and patients reached by the mobile van.
Methods:
Patients screened for breast cancer through mobile mammography were extracted from the electronic health record. Between 2021 and 2025, 3,662 patients were screened, across 418 mobile events, held with 176 community partners. Data were stratified by CNPI-BCS quintile, and Spearman rank correlation was used to evaluate trends by subgroup. Concordance between patient residential and screening locations was assessed. Multilevel logistic regression was used to estimate correlation of CNPI-BCS and underscreening (rarely/never screened) among mobile screening unit patients. Model performance was evaluated for discrimination and calibration.
Results:
The top CNPI-BCS quintile (n = 243 tracts) represented the highest-need communities, where the most events were held (n = 188, 45%) and the most patients were screened (n = 1,616, 44%). Underscreening rates increased monotonically from the lowest-need quintile (27%) to the highest-need quintile (47%). Forty-four percent were screened in the same quintile in which they lived. CNPI-BCS was positively associated with higher odds of underscreening (odds ratio, 1.20 per 0.1-unit [95% CI, 1.08 to 1.33]; P < .001). Receiver operating characteristic analysis showed satisfactory discrimination (corrected AUC = 0.692; apparent AUC = 0.735 [95% CI, 0.718 to 0.752]).
Conclusion:
Findings demonstrate that CNPI-BCS accurately identifies screening need among a mobile mammography patient cohort, offering an evidence-based framework for identifying priority areas for breast cancer screening interventions.
