Specific Aims
NC-BCSP was originally launched as an eight-year project (1992-2000) to promote mammography use by older African American women in five counties: Beaufort, Bertie, Martin, Tyrrell and Washington. During its first eight years, NC-BCSP achieved its primary objective of increasing mammography use by African American women ages 50 years and older. The project's success in breaking the silence that has surrounded breast cancer provides a solid foundation for developing and testing new initiatives to improve the health of older, rural African American women. Specific aims for 2000-2003 are to:

Expand the target population to include African American women 40 years and older. From 1992-2000, NC-BCSP targeted women 50 years and older for mammography, as recommended by the National Cancer Institute (NCI). Today, expert groups, including NCI and the American Cancer Society, endorse mammography every 1-2 years for women ages 40 and older.

Increase initial use of screening mammography by women who have never had a mammogram. Initiation of mammography by all women is imperative to closing the screening gap between black and white women. After 8 years of NC-BCSP intervention, despite movement in a positive direction, black women remain more than twice as likely as white women to report they had never had a mammogram (19.3% versus 9.7% ).

Increase repeat mammography screening by African American women. Despite a significant national increase in recent mammography use by women 50 and older (from 27% in 1987 to 74% in 1997), long-term adherence to a screening schedule is low for rural black women. Only 64% of black women in NC-BCSP intervention counties in the year 2000 adhered to a regular screening schedule (2+ mammograms in the past 5 years) compared to 78% in our project's white comparison group.

Increase the rate of Pap testing among African American women ages 40 and older. NC-BCSP plans to expand its mission to address the problem of late-stage diagnosis of cervical cancer in African American women. North Carolina Cancer Registry statistics show that in NC-BCSP counties black women are more likely than white women to be diagnosed with late-stage cervical cancer (63% vs. 43%).

Secondary Aims
In addition to the specific aims listed above, NC-BCSP has a number of secondary objectives:

improve women's knowledge of, attitude toward and intention to obtain screening mammograms and pap tests;
investigate the relation between cancer anxiety and screening activities such as mammography and pap testing;
improve providers' skills in counseling women for mammography;
determine which aspects of NC-BCSP interventions are most effective for increasing mammography use, and;
promote the diffusion of effective interventions