Target messages for annual breast cancer screening

Use community liaisons to help build confidence

Education about early detection of breast cancer through regular screening has boosted the number of women getting mammograms. About 10 years ago, older women were not getting mammogram screenings as frequently as younger women, even though older women are at higher risk for breast cancer. Now the numbers seem fairly even, says Debbie Saslow, PhD, director of breast and gynecologic cancer for the American Cancer Society in Atlanta. Also, it looks like the gap between African American women and Caucasian women has just about closed.

"I think the numbers are at a plateau because they are so high, and we have reached the easy-to-reach women. It is much harder to get those last 20% to 30%," she says.

One message targeted to a particular segment of the population — whether Caucasian, African American, Asian, or Hispanic women — does not work. There is diversity within every group, says Zora Brown, founder of the Breast Cancer Resource Committee in Washington, DC.

Brown reports that in recent years, breast cancer awareness efforts have been event-driven and, while women may get caught up in the activities, many have become lackadaisical when it comes to regular screening. Even though they are knowledgeable about screening, they don’t necessarily get the mammogram, she says.

"I think we have to freshen the message we have been delivering about early detection and eliminate some of the noise," says Brown.

Saslow says it is unclear which segments of the population are receiving the message but not acting on it, and therefore need to be reached in a different way.

It is important to determine the barriers to early detection within a patient population and target them. Strong predictors for the use of early-detection methods for breast cancer include poverty, insurance status, educational level, English vs. non-English-speaking, and the number of years a person has lived in the United States, says Saslow.

To reach women, a trusting relationship must be built between people within neighborhoods and the medical institution, suggests Cathy Cole, RNP, MPH, a breast health specialist at Cooper Sinkel Women’s Health Center at City of Hope National Medical Center in Duarte, CA.

It’s important to determine what it is about a particular culture or group that motivates them to come for screening, she says.

"It is a very long process. You have to build trust in the communities and continue to search for avenues to do this whether in print media, local radio stations, or through community based organizations, such as the YMCA or local chapter of the American Cancer Society," says Cole.

One way to connect is to determine where women congregate. For example, there may be a lot of mothers with school-age children who you would find at school-related activities such as PTA meetings.

"You have to go into the communities with language they understand, both in terms of sophistication of medical language, and in their native language, which may not be English," says Cole.

Design community specific programs

To provide easy access to mammograms after a relationship had been built between the medical community and its service areas, City of Hope initiated a mobile mammography program. To make the mobile mammography program successful, staff from the women’s health center found women within the community to be their liaisons. They discovered one woman at a time by visiting churches, beauty shops, and markets as well as advertising in the local print media. Potential liaisons then were invited to attend a meeting on the program.

The liaisons went to their neighbors to explain the importance of breast health screening and brought them to a community-based site where the mobile mammography van was scheduled for the day. Interpreters who spoke the languages of the women within the community also were on the van.

The message about screening for early detection of breast cancer always highlighted what was important within that particular culture or patient group. For example, in Hispanic communities, the nuclear family is very important; therefore, women were encouraged to remain healthy to take care of their family.

If follow-up was needed after the mammogram, a local clinician who understood the culture and income barriers was found to see the patient. "We had a whole network of community leaders, professionals, and clinical people working toward early detection, diagnosis, and treatment if needed," says Cole.

Women who have breast cancer or who have recovered from it make excellent spokeswomen, says Brown. Also, speaking to small groups of women at convenient times is a good way to deliver the message, she says.

However, the message to women is not that they should have a mammogram, but that they should be screened yearly after the age of 40.

Once women are brought in for screening, a secondary barrier or challenge is to get them to return year after year. "We need to create an atmosphere where women will return many times, and hopefully to the same institution so we have historical evidence of what has gone on in her breast health over time," says Cole.

Getting physicians to recommend screening for early detection of breast cancer is an important factor as well as reminding them to have a mammogram each year, says Saslow.

Medical clinics and mammography centers should adopt a technique that many dentist offices use: Have women make appointments for mammograms for the following year after their screening, says Brown. At dental offices, people often make an appointment for their next exam after their semiannual teeth cleaning and screening. At that time, they fill out a postcard that will be sent later as a reminder.

Access to health care is another factor that keeps people from getting annual mammograms, says Saslow.

Cole says she never worries about the woman who has insurance and stability. She worries about the underserved or undertreated woman who is disenfranchised, who doesn’t have the sophistication to know where her options are and what groups of professionals will continue to see her despite the fact that she might not have money or insurance.

Sources

For more information about targeting education to specific patient populations, contact:

Zora Brown, Founder, Breast Cancer Resource Commit-tee Inc., 2005 Belmont Road, N.W., Washington, DC 20009. Telephone: (202) 463-8040. E-mail: ZorBrw@aol.com

Cathy Cole, RNP, MPH, Breast Health Specialist, Cooper Sinkel Women’s Health Center, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010. Telephone: (626) 256-4673, ext. 60020.

National Breast Cancer Awareness Month, Susan Nathanson, National Coordinator, 233 N. Michigan Ave., Suite 1400, Chicago, IL 60601. Telephone: (312) 596-3557. E-mail: susan_nathanson@chi.bm.com

National Mammography Day, American Cancer Society, 1599 Clifton Road, N.E., Atlanta, GA 30329. Telephone: (800) 227-2345. Web site: www.cancer.org