Mobile Mammography Outreach in Communities with Unmet Health Needs: Assessment of Appointment Outcomes and Operational Insights from Texas, United States

Background

Breast cancer screening through mammography is a critical preventive service that reduces mortality by facilitating early detection. However, Communities with unmet health needs – often characterized by socioeconomic, geographic, and systemic challenges – face lower screening rates and higher later-stage diagnoses.^[1,2] Texas, the second most populous state in the U.S., is home to over 30 million residents and is marked by wide geographic and demographic groups. A significant portion of its population live in neighborhoods with unmet health needs, with large segments identifying as Hispanic, Black or African-American, or low-income – groups that historically face structural barriers to preventive care, including mammography services.^[3] These disproportionate outcomes are especially pronounced in communities served by (i) federally qualified health centers (FQHCs), (ii) community-based organizations (CBOs), (iii) faith-based organizations (FBOs), and (iv) university outreach programs at Texas Southern University Breast Cancer Screening and Prevention Center (TSU BCSPC). Public health fieldwork that brings mobile mammography to these settings can help close the gap in screening access.

Objectives

This project aimed to (1) quantify screening uptake – measured by patients scheduled, serviced, no-shows, and cancellations – across four aforementioned partners and five counties from March 2022 through November 2024, (2) screening mammogram outcomes-measured by normal versus abnormal results, and (3) identify operational patterns to inform future outreach strategies.

Reporting Guideline

This study follows the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for cross-sectional studies.^[4] The project was organized by TSU Breast Cancer Screening and Prevention Center (TSU BCSPC) in collaboration with FQHCs, CBOs, and FBOs, who aimed to increase access to screening mammogram in communities with unmet health needs.

Study Design

A retrospective fieldwork analysis was conducted across four site types (FQHC, CBO, FBO, and TSU) to evaluate appointment outcomes and screening mammogram outcomes through a mobile mammogram unit.

Sampling Strategy

Sites were selected to represent different community settings serving population with unmet health needs. All patients who received a screening mammogram on the mobile unit between March 2022 and November 30, 2024, were included in the study.

Data Collection

Screening data were extracted from organizational records, including appointment dates, site location, patients’ county, mammogram results, and outcome counts.

Ethical Considerations

The study was reviewed and approved by the Institutional Review Board of TSU. Informed consent was waived due to the use of de-identified administrative data.

Setting

Screenings were conducted in four settings: FQHCs, CBOs, FBOs, and the TSU campus in Houston, TX. Community outreach was essential for engaging participants in this program. Trust-building played a critical role, particularly in faith-based settings where familiarity and endorsement by local leaders boosted turnout.

Participants

Participants included individuals aged 40–75 years residing in various counties, who received screening mammograms through a mobile unit.

Timeline

Fieldwork occurred from March 01, 2022, to November 30, 2024.

Challenges and Adaptations

Operational challenges included variable patient outreach effectiveness and equipment downtime; these were addressed by flexible scheduling and backup mobile units.

Quantitative Results

Between March 2022 and November 2024, 1,295 mammography appointments were scheduled across 56 mobile events serving communities with unmet health needs. Of these, 832 (64.3%) were completed, 325 (25.1%) were no-shows, and 137 (10.6%) were cancelled. One individual was marked as “arrived” but not serviced or cancelled.

FQHCs had the highest volume, with 701 schedules (54.1%) and 418 completions (50.2%), but also the highest share of no-shows (62.5%) and cancellations (59.9%). CBOs followed with 329 schedules and 226 completions, while FBOs and TSU hosted fewer events, with lower but proportional turnout and cancellation patterns [Table 1].

County-level analysis showed Harris County accounted for most activity – 872 schedules (67.3%), 570 completions (68.5%), and the majority of no-shows (68.9%) and cancellations (54.7%). Other contributing counties included Matagorda, Grimes, Wharton, and Walker, each representing <11% of the total volume with similar performance metrics [Table 1].

Time trend analysis across the 33-month study period revealed no statistically significant changes in scheduling, service delivery, no-shows, or cancellations. Although some month-to-month variation was observed, including a peak in August 2022, regression analyses showed flat trends across all four measures (p > 0.45 for each) [Figure 1].

Figure 1:

Trends in the monthly mammography screening outcomes (March 2022–November 2024). Scheduled: Slope = −0.32, p = 0.474, Serviced: slope = −0.13, p = 0.652, No-Show: slope = −0.12, p = 0.452, and Cancellation: slope = −0.07, p = 0.482.

Demographic differences were evident between those who were serviced and those who missed appointments [Table 2].

The largest age group was 40–49 for both categories. Older adults (65+) comprised the least proportion of no-shows. Black or African-American individuals made up a larger proportion of no-shows (29.2%) than serviced participants (17.7%), while Hispanic and White individuals were the majority among those who completed screenings. Notably, 85.3% of those who were serviced were uninsured, compared to 74.5% of no-shows. Among those who received screenings, 83.5% had benign results, and 16.5% required follow-up imaging.

Qualitative Insights

Although primarily quantitative, staff feedback indicated that community outreach at FBOs facilitated trust-building among participants. Staff noted that participants were more likely to engage when screenings were hosted by familiar faith leaders or held at trusted community venues, leading to increased comfort and follow-through. One outreach coordinator shared, “When the pastor announced the screening during Sunday service and stood beside us on event day, the turnout was significantly better – we saw new faces who wouldn’t usually attend.”

Interpretation

Service rates (84% overall) align with national benchmarks but are lower in FBO settings, possibly due to less formal appointment systems.^[5] Seasonal dips in summer months underscore the need for adaptive scheduling.

Implications and Lessons Learned

Embedding mammography services within established FQHC workflows yielded the highest uptake; replicating similar processes in FBO and TSU settings could improve reach.

Recommendations

Standardize reminder calls and provide transportation vouchers, especially during high drop-off months. Future research should explore patient engagement strategies tailored to faith-based communities. The coalition was formed by strategically selecting community partners who were already embedded within the target populations. This approach allowed the outreach to leverage trusted community relationships and established infrastructures. While embedding services in FQHC workflows was highly effective, less formal systems at FBO and TSU sites resulted in lower service rates. The lack of significant monthly trend improvements suggests that further interventions are necessary. Key lessons learned include the importance of trust-based partnerships, tailored outreach strategies, logistical flexibility, and supportive interventions such as transportation assistance and reminder calls. These insights can guide similar efforts globally.

Key Messages

(1) Mobile mammography partnerships with different sites and counties in Texas reached women in communities with unmet health needs effectively – 64% of 1,295 scheduled appointments were completed – highlighting the value of bringing services into community settings. (2) Attendance varied by partner type and location: FQHCs drove most volume but also the highest no-show rates, while faith-based and university sites saw lower uptake, indicating the need for tailored reminder and support strategies. (3) No significant trends in scheduling or attendance emerged over 33 months, underscoring the importance of flexible outreach (e.g., backup units and adaptive scheduling) and targeted interventions (reminders and transportation vouchers) to sustain screening equity.