Workplace-Based Breast Cancer Screening Intervention in China Running title: Breast cancer intervention in China

Background: Breast cancer continues to be the primary cause of death among East and Southeast Asian women. Although China, the most populous country in the world, is experiencing unprecedented economic growth, its healthcare system has yet to benefit from the current economic prosperity. Indeed, studies have shown a consistent rise in breast cancer rates among Chinese women over the past two decades in the absence of breast cancer screening guidelines. Methods: The primary objective of this study was to examine the impact of a workplace intervention on increasing breast cancer screening rates. The study was implemented at eight worksites in Nanjing, four of which were assigned to the intervention group (n= 232) and four to the control group (n=221). The intervention group received breast cancer education and screening navigation. The control group was provided with general cancer education and received a delayed intervention after completion of the study. Study measures were completed at preand post-program and at 6-month follow-up to assess uptake of mammography. Results: Baseline mammography use was low among both intervention and control groups. However, exposure to the workplace intervention dramatically increased the uptake of mammography from 10.3% at baseline to 72.6% at 6-month follow up in the intervention group (P<0.001). Conclusion: Findings provide preliminary evidence that the implementation of a comprehensive workplace breast cancer screening intervention program in China can lead to increased uptake of mammography. These data may help facilitate the development of theory-based workplace cancer prevention programs and screening guidelines in China. Impact: A workplace-based multifaceted intervention could have a strong impact in breast cancer prevention and early detection among women in China.