Earp, J.A., Eng, E., O'Malley, M.S., Altpeter, M., Rauscher, G., Mayne, L., Mathews, H.F., Lynch, K.S., and Qaqish, B.  American Journal of Public Health, 92(4):646-654, April, 2002.

Objectives: Breast cancer screening rates are lower in disadvantaged populations.
We undertook a community trial to evaluate the effectiveness of The North Carolina Breast Cancer Screening Program, a lay health advisor network intervention, supplemented by activities to improve mammography access and quality, intended to increase screening among rural African American women ages 50 years and older.
Methods: A stratified random sample of 801 African American women (390 intervention; 411 comparison) completed baseline (1993-1994) and follow-up (1996-1997) surveys. The primary outcome was self-reported mammography use in the past two years.
Results: The intervention was associated with an overall 6 percentage point increase (95% CI: -1, 14) in community-wide mammography use. Low-income women in intervention counties reported an 11 percentage point increase (95% CI: 2, 21) in use above that reported by low-income women in comparison counties. Adjustment for potentially confounding characteristics did not change results.
Conclusions: A natural helper lay health advisor intervention appears an effective public health approach to increasing screening mammography in low income, rural populations.