Howard W. Peak

Coalition Plus Public Health Nurses Meet Screening Needs of Underserved Women

All women are at risk of developing breast cancer during their lifetime. It is the most commonly diagnosed cancer among American women and the second leading cause of cancer deaths. But early detection through screening is the key to more treatment options and a dramatic increase in survival rates. The City of San Antonio Breast Cancer Screening Program exemplifies positive strategies to assist low-income women in awareness and screening.

The program targets women who have an income at or below 200 percent Federal Poverty Level and no insurance or cannot meet the deductible of their insurance plan. These women traditionally do not seek medical care for their medical needs because of the financial strain it causes .to the family.

The City of San Antonio Metropolitan Health District (SAMHD) has been a leader in providing breast cancer screenings to these women since 1991. Through funding received from the Texas Department .of Health Breast and Cervical Cancer Control Program (BCCCP), the program has served 5,800 women. To date, 1,824 women have received early diagnostic interventions that have been successful in decreasing the threat of cancer. Thirty-two women have been diagnosed with breast cancer and have been referred to appropriate treatment options.

Cooperation as the Facilitator

A strong emphasis on coalition building among the breast cancer screening providers of San Antonio has been a major objective since the conception of the program and has resulted in the following rewards:

1) a fully funded case manager to .support women in obtaining .diagnostic procedures;

2) less duplication of services among providers; and

3) a unified effort to raise awareness throughout the community.

In regard to the latter reward, San Antonio’s extensive celebration of National Breast Cancer Awareness Month provides a good example of how the combined efforts of all providers can effectively promote awareness.

Mammograms for Women Under 50

The Texas Department of Health Breast Cancer Screening Program limits eligibility to women 50 to 64 years of age. From the city’s history with this program, there is .an unmet need for low- cost screening mammograms for women from 40 to 50 years. Many women within this age group have come to the attention of the screening program due to self-assessments of a breast lump. Through collaboration, the City of San Antonio received additional funding from the Susan G. Komen Foundation .for screening and diagnostic services for women under the age of 50 who are at .high risk for breast cancer or have breast cancer symptoms.

Another major supporter of detecting breast cancer in low-income women .is the Young Women’s Christian Association (YWCA) EncorePlus and Methodist Healthcare Ministries. .These organizations provide additional funding for women with symptoms of breast cancer who cannot afford diagnostic procedures. To date, the YWCA and Methodist Healthcare Ministries have .contributed $6,720.

The support of these agencies for mammograms for younger women is one more example of the benefits of collaboration. SAMHD continues to enhance its coalition efforts by reaching out to other organizations within the community that are interested in breast cancer awareness.

Public Health Nurses at the Forefront

The foundation of the SAMHD Breast Screening Program lies in the ability to maximize the current public health clinic structure. SAMHD operates neighborhood clinics in a variety of sites throughout the city. The program staff – consisting of R.N.’s, L.V.N.’s, and Public Health Aides – provide monthly screening clinics at the targeted neighborhood sites. Currently 14 clinics are scheduled. Through the efforts of SAMHD, an added bonus to this screening process is that a mobile mammography unit – operated by South Texas Radiology Imaging Centers – comes to designated clinic sites, allowing for patients to have easy access to mammograms. The patients enrolled in the program have commented that this is the best part of the service.

The long-term success of this program has been the public health nurse’s role in management of the patient. Because of the .public health nurse focus, the patient’s .total health status is assessed with each visit, inclusive of a complete health history with Pap smear and appropriate laboratory testing. Each clinic is staffed not only with the program staff, but also with a physician .or nurse practitioner who provides the medical examination. For any abnormal finding, a public health nurse is assigned immediately to make contact with the patient and develop a plan of care. Through the network of the coalition, the public health nurse has an extensive referral system to assist the patient in receiving care.

The annual screening visit provides patients with an opportunity to discuss health .concerns with the public health nurse. Nutrition, exercise, and healthy heart are examples of health topics presented by the staff. Additionally, through collaborative efforts with YWCA, self-breast exam teaching is offered in the waiting area prior to the patient’s examination.

Targeted Health Fairs

In order to recruit new patients and increase the level of public awareness toward breast cancer, the program staff participates in numerous outreach projects. Last year .the staff participated in 22 events reaching 1,500 people. From working with patients in the program, it was determined that there was a potential for reaching more Hispanic and Black women by offering health fairs specifically designed for these ethnic groups. In 1995, the first Latina Women’s Health Fair and the first Black Women’s Health Fair were offered. Both fairs were held in convenient locations for both groups, with mobile mammography services at each fair. This year will be the fifth annual fair for both groups.

Future Plans

It is estimated that twenty-six percent .of the women in the San Antonio area are uninsured and live below the 200 percent poverty level. The need for SAMHD to continue to place emphasis on this important issue cannot be overlooked. To this end, SAMHD plans to continue to reach out to the community to target these women.

The health district also continues to look .to the community for contributions to aid in its fight for more monies to support low-income women in obtaining screening and diagnostic services for breast cancer. Community fundraisers are a major source for augmenting public funds for this purpose, as demonstrated by Run 4 Life – .conducted in partnership with the Cancer Therapy and Research Center – held on October 9, 1999 with twenty-three different sponsors and generating $30,000 for more mammograms.

For more information, please contact:

Fernando A. Guerra, M.D., M.P.H.
Director of Health
San Antonio Metropolitan Health District
telephone: 210/207-8780