PROJECT SUMMARY/ABSTRACT This proposal builds on the strong relationships between Siteman Cancer Center’s (SCC’s) Community Outreach and Engagement (COE), the Missouri Cancer Consortium (MCC), and the Department of Health and Senior Services (DHSS) to develop a state-wide approach targeting counties with the highest breast cancer mortality rates in Missouri. Many of these counties are rural and have limited resources and access to mammography facilities, leading to mammography rates below the state and national average pre-pandemic. Given the existing disparities in cancer screening and the fact that many of these counties lie outside of the SCC catchment, COE has partnered with state and local resources to develop strategies related to cancer prevention, screening, diagnosis, and patient navigation with the goal of expanding mammography in these target counties. As part of our gap analysis, we will intentionally examine social and structural determinants across multiple levels of influence. These multilevel factors of influence include individual, interpersonal/family, organizational, neighborhood, and societal. This proposal will make use of existing work groups and relationships between stakeholders to assess the organizational capacity of federally qualified health centers and Show Me Healthy Women providers to ramp up mammography screening to address the urgent need for cancer screenings in these counties. To accomplish our goals, our aims are to: Aim 1: To conduct a needs assessment among mammography providers in the target counties to assess the presence and need for patient navigation and mobile mammography. Aim 2: To implement new or expand existing patient navigation within mammography providers in the target counties. Aim 3: To evaluate the success of the implementation. This proposal extends our current partnership with the MO Cancer Consortium and the MO Comprehensive Cancer Control Program to implement a sustainable, evidence-based intervention in the highest need, rural counties in Missouri. Developing this infrastructure and awareness of resources integrated into local primary care and health departments will provide a foundation to expand additional cancer prevention and screening services.