Taking mammogram education to our neighborhood streets

In 2014, we made a shocking discovery. While analyzing the data for women who came to our hospital for breast cancer treatment between 2006 and 2011, we found that nearly 22 percent of them had stage 3 or 4 breast cancers—nearly double the national average of 10.5 percent.

Most of these women were African-American, and 54 percent of them lived in the District of Columbia. And of these D.C. residents, 40 percent of them lived in Ward 5, our hospital’s neighborhood. But what baffled us the most was that 97 percent of the Ward 5 patients with advanced breast cancer had health insurance.

This was especially surprising to me because of my work at the Cancer Preventorium, where we see people who have no symptoms for regular physical exams and cancer screenings such as mammograms. About 95 percent of the patients I see are Latino, most of whom are poor and without health insurance. They pay out of pocket for these preventive health visits, but do so because they know how important these screenings are.

So why were so many women who had access to preventive healthcare being diagnosed with advanced breast cancer? With help from a generous grant from the Avon Foundation for Women, we started the Get2Breast CARE (Cancer Awareness & Resource Education in Ward 5) program to find out why and to design an intervention to reverse the trend. In September 2017, we published the results of what we’ve learned so far.

Phase 1: What’s keeping women from getting mammograms?

Before we could do anything, we needed to find out why our female neighbors weren’t getting mammograms, the first line of defense against breast cancer. We sent community navigators out to survey 1,092 women in Ward 5.   

The reasons we discovered included:

  • Fear: Twenty-seven percent of women were afraid of a possible breast cancer diagnosis and the accompanying side effects and costs of treatment.
  • Personal factors: Twenty-eight percent reported that they were too busy taking care of other family members or couldn’t take time off work to get a mammogram.
  • Lack of education: Thirteen percent didn’t understand breast cancer risk factors, didn’t know when they should start getting a mammogram or that they needed them at all, or were unaware that their health insurance would cover them.
  • Access: Seventeen percent said they would be more likely to get a mammogram if it were more convenient, such as being able to go before or after work, on weekends, or if screening was available closer to home.
  • Mammogram misconceptions: The remaining reasons included myths, such as getting a mammogram is painful or that radiation from a mammograms actually could cause cancer.   

Phase 2: Getting the word out about mammograms

Now that we were armed with the knowledge of why women weren’t getting mammograms, we developed educational materials based on that information. And our community navigators headed back out to coordinate outreach activities in the neighborhood. These materials and events focused on dispelling fear and empowering women to overcome personal barriers to receive potentially lifesaving mammograms. 

Our amazing community navigators didn’t all have healthcare backgrounds, but they did have a passion to educate and a deep understanding and insider knowledge of the neighborhood. They knew the best places to reach their female neighbors, such as local businesses, churches and community centers. They also knew who they needed to talk to in order to make the event as successful as possible. For example, if they wanted to reach women from a certain church’s congregation, they knew to talk to the pastor’s wife, not the pastor. 

There’s been some confusion in past years about when and who should get a mammogram. This is due to conflicting guidelines from various health organizations. We urged women in our outreach efforts to follow their doctor’s recommendations based on their unique risk factors. We also shared the American Cancer Society guidelines, which say women at average risk of breast cancer can begin having yearly mammograms at age 40 if they choose, but definitely should begin having them by age 45. At age 55, they can start having mammograms every other year.   

Avon Get2Breast Care Community Navigators (left to right)
Janel Diaz, Lynel S. McFadden and Volunteer Community Navigator Sybil L. Smith

Time for your mammogram? Request an appointment.

The community navigators gave a short survey before and after every educational event to ensure that women were getting the message. We found a 15 percent increase in the participants who believed that “a mammogram is the safest and most effective test available for finding early breast cancer.” Along with the educational events, we offered to schedule mammograms and to help navigate the process if the test yielded suspicious findings.

What’s next: Expanding the program across the city and including other cancers

I’ve seen firsthand the effect education and awareness can have on cancer prevention. I’ve been privileged since 1989 to host a daily one-hour radio broadcast called “El Consultorio Comunitario” (“The Community Clinic of the Air”), which gives disease prevention and health promotion messages on D.C.-area Spanish-language station Radio America WACA 1540AM, Monday through Friday, and via the Internet. The wide reach of this program likely plays a big role in why we see so many of our Latino neighbors at the Cancer Preventorium, despite the fact they may need to pay two-days’ worth of salary for the exam and screening.

The success of our intervention program in Ward 5 left us wanting to expand it further into the city. The Avon Foundation for Women stepped up again, helping to extend the experience to women in Wards 7 and 8. Nearly 70 percent of all women treated with breast cancer at our hospital come from the three wards in which we’re now working. We’re also excited to be talking with the Department of Health in D.C. about adopting our approach and taking it city-wide. And after finding the same disparity (insured people with advanced colorectal cancer) we started a similar approach to tackle colorectal cancer from the neighborhood.

We hope, through these intervention efforts, to see fewer women in D.C. diagnosed with advanced breast cancer in the future. Instead, we want to see more women for regular mammograms to detect breast cancer early, when the disease is easier to treat.

Improving Breast Health: One Ward at a Time

Screening tests are a powerful weapon in the fight against breast cancer. Mammography is a breast cancer screening tool used to help doctors pinpoint when a change has occurred in a woman’s breast. In spite of these benefits, and in spite of having health insurance, too many women in Washington, D.C. are forgoing their annual mammograms out of fear. For the last two years, breast health navigators at MedStar Washington Hospital Center have been working passionately to reverse the trend. After first focusing on women in the District’s Ward 5 neighborhood, the hospital’s Get2Breast CARE program is expanding across the city into Wards 7 and 8, thanks to a generous $100,000 grant from the AVON Breast Cancer Crusade.

“Early detection and early treatment of breast cancer increases the chance of survival,” said Elmer Huerta, MD, MPH, director of the Cancer Preventorium at the Washington Cancer Institute at MedStar Washington Hospital Center. “It is shocking to see that 97 percent of women with advanced breast cancer treated at the Hospital Center have health insurance. This validates the need to offer breast health education in the community.”

Research led to a Successful Partnership

During Phase I of the program, as part of the Get2Breast CARE (Cancer Awareness & Resource Education in Ward 5) program, which was funded by the Avon Foundation for Women, breast health navigators surveyed 1,091 women over the course of a year, to find out what they know about breast cancer and breast cancer services and to know why they were postponing their mammograms in spite of having health insurance. Of the 1,336 personal opinions that were analyzed from the 31-question survey, 22.7 percent noted fear and 23.5 percent noted personal factors as reasons for delaying or skipping routine mammograms, the first line of defense to look for early signs of breast cancer. In their opinions, many respondents indicated fear of cancer, treatment, receiving bad news and abandonment, as well as personal reasons such as a busy lifestyle, no time to see a doctor, laziness and lack of preventative health education in their answers.

During Phase II of the study, also funded by the Avon Foundation, women told us that having more access to mammography facilities and more educational programs were important factors to increase the number of women getting checked.

Those successful outreach efforts have led the Avon Breast Cancer Crusade to award the Washington Cancer Institute another grant for the third year in a row, to provide more education, screening and patient navigation services to women not only in Ward 5, but also in Wards 7 and 8. The team will host educational events, mammography services and follow up care, if needed.

“Empowering women with life-changing knowledge about prevention, and teaching them how to use their health insurance coverage will make a difference,” added Dr. Huerta.

Have any questions?

For more information, please call 202-525-9281.

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High Rate of Advanced Colon Cancer Found Among African Americans in Ward 5

Colon Cancer Prevention in the Neighborhood Program Launched, Part of White House Cancer Moonshot

Washington, D.C., October 17, 2016
– Colon cancer is one of the very few preventable cancers, but too many residents from the District of Columbia’s Ward 5 are diagnosed with advanced colon cancer. Today, MedStar Washington Hospital Center is launching its “Colon Cancer Prevention in the Neighborhood” program, to increase early detection and prevention of colon cancer. The program focuses on African-Americans in the Ward 5 neighborhood, where a crisis of late-stage colon cancer exists. “Colon Cancer Prevention in the Neighborhood” is part of Vice President Joe Biden’s Cancer Moonshot efforts to ensure cancer care is equitable throughout the nation.

Of 1,314 men and women treated for colon cancer from 2006 to 2011 at the Hospital Center, 892 of them, or 68 percent had stages 2 through 4 colon cancer. Of those, nearly 50 percent of stage 3 and 4 colon cancer patients were from Ward 5, echoing a number of studies that consistently show the highest yearly prevalence of colon cancer in the District is among Ward 5 residents. The data also revealed 91 percent of those with stage 3 and 4 colon cancer were African-Americans. Even more alarming, 97 percent of those presenting with advanced colon cancer had health insurance at the time of their diagnosis.

“It is shocking to see that this many residents who have insurance coverage are presenting late, with a disease that could have been detected earlier with screening,” said Elmer Huerta, MD, MPH, director of the Cancer Preventorium at MedStar Washington Hospital Center’s Washington Cancer Institute. “This data validates the need to offer accessible colon cancer screening and education in the community.”

The “Colon Cancer Prevention in the Neighborhood” program will deploy patient navigators to work with Ward 5 residents, building community-based partnerships to deliver colon cancer education, perform risk assessments and distribute easy-to-use fecal immunochemical (FIT) tests that can be done at home. The FIT test measures tiny amounts of blood in the stool that can be a sign of cancer or large polyps. The program will also offer services to connect patients with colonoscopy services, supporting the goal of significantly increasing screening rates among Ward 5 residents. The community-based program is supported by the Herb Gordon Foundation for Gastrointestinal Cancer, the American Cancer Society and private donors.

For the past three years, breast health navigators at MedStar Washington Hospital Center have been actively working in the Ward 5 community to improve breast cancer screening. Hospital Center data found similar results as with colon cancer: 97 percent of the Ward 5 patients with advanced breast cancer were African-American women with health insurance coverage. Thanks to grants from the AVON Breast Cancer Crusade, the breast cancer outreach program is now expanding across the city into Wards 7 and 8.


About the Cancer Moonshot:
During his 2016 State of the Union Address, President Obama called on Vice President Biden to lead a new, national Cancer Moonshot, focused on making a decade's worth of progress in preventing, diagnosing, and treating cancer in five years - ultimately striving to end cancer as we know it. A Presidential Memorandum on January 28, 2016 established the Cancer Moonshot Task Force.

 After meeting with experts across the country and the world, Vice President Biden identified areas of focus for the Cancer Moonshot -- based on barriers to progress and opportunities for improving patient outcomes - and announced a first wave of accomplishments at the Cancer Moonshot Summit on June 29, 2016 at Howard University in Washington, D.C. On Monday, October 17, Vice President Biden is releasing the final report of the Cancer Moonshot Task Force, along with his own Executive Findings after traveling to many of the major nerve centers in the cancer community. He will also unveil a new set of Federal actions, private sector actions, and collaborative partnerships to further advance the goals of the Cancer Moonshot Task Force. More information on the Cancer Moonshot can be found here.


About MedStar Washington Hospital Center:
MedStar Washington Hospital Center is a 926-bed, major teaching and research hospital. It is the largest private, not-for-profit hospital in the nation’s capital, among the 100 largest hospitals in the nation and a major referral center for treating the most complex cases. U.S.News & World Report consistently ranks the hospital’s cardiology and heart surgery program as one of the nation’s best. It also is a respected top facility in the areas of cancer, diabetes & endocrinology, Ear, Nose & Throat, gastroenterology & GI surgery, geriatrics, gynecology, nephrology, pulmonology and urology. It operates MedSTAR, a nationally-verified level I trauma center with a state-of-the-art fleet of helicopters and ambulances, and also operates the region’s only adult Burn Center.

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