Mobile Mammography Shows Benefits on Multiple Levels
Marie LaFargue, MPH, Director Oncology Programs
MemorialCare® Cancer Institute at
Orange Coast Memorial Medical Center, Fountain Valley, CA
Louisville is part of Jefferson County, where 48,324 screening mammograms were performed during the time frame above. It was documented that 44% of the women screened were uninsured. Within this Jefferson County population, White women were most likely to get screened at 63.9%,while Black women participated at a rate of the effectiveness of mobile mammography has been questioned over many years by clinical providers as well as consumers. The fact that mobile mammography has become a concept whose time has come was highlighted at the 2014 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium (BCS) meeting in San Francisco, CA. A major study was presented that clearly showed evidence of its impact in screening mammography populations.[i] At this highly reputable meeting, researchers at the University of Louisville in Kentucky reported that mobile mammography has improved the utilization of breast cancer screening among uninsured women. It is believed that this study represents the largest database of mobile mammography encounters shown in the literature.
The reported data encompasses a time period dating from January 2001 through December 2010. 29.1%, Hispanic women at 3.8%, and Other women at 3% respectively. While race is an important factor to consider in evaluating mobile mammography screening, it was insurance type that prevailed in the data as the strongest predictor of whether women would return for subsequent screening. This study showed that uninsured women were most likely to make use of mobile mammography for screening—regardless of race.
On a local level, and in reported data outside of a formalized study, organizations have demonstrated similar findings. In interviews by the author with Susan G. Komen Orange County and the Watts Healthcare Corporation, it was reported that these respective organizations have experienced a high return rate of women using screening mammography services—often with long-term follow-up of participants. Susan G. Komen Orange County and the Watts Healthcare Corporation have primarily focused on Latina and African American women in their reach to underserved women as they have historically experienced the highest rates of late-stage breast cancer diagnosis. [ii]James Johnson, R.T., B.S.R.S., Radiology Manager, of the Watts Healthcare Corporation heads their mobile mammography program that celebrates implementation of a 22-year program that has faithfully served some of the most vulnerable populations in Los Angeles County. Many of the largely African American and Latina women in the community have used their services until they find employment and/or gain health care coverage through government-sponsored insurance options. They have accessed services through Watts Healthcare Corporation at partnering community clinics, community events, health fairs, faith-based organizations, YWCA of San Pedro-Encore Plus program, and Telemundo [a Spanish language TV Network]., In addition, there is an annual gathering of programs/services focused on women’s empowerment at the KJLH FM radio-sponsored “Women’s Health Forum” that started 13 years ago at what was known as the Hollywood Park Race Track in Inglewood, CA. The “Women’s Health Forum” outgrew this venue and in the most recent years relocated the event to the Los Angeles Convention Center in downtown Los Angeles. KJLH radio is owned by musical legend and entrepreneur - Stevie Wonder.
The mobile mammography program at Watts Healthcare Corporation serves about 2,500 women per year. Mammography screening is provided under the auspices of the State of California Every Woman Counts program. The program has experienced a return rate of nearly 70% for annual mammography follow-ups, and typically detects on average 7 cancers annually.
Another shining example on the local front of outstanding community-based efforts to reach underserved women is the work of Susan G. Komen Orange County. The Orange County Affiliate established a collaborative community partnership with trusted organizations in the Latino community—Northgate Gonzalez Markets and one of Susan G. Komen Orange County’s grantees, the YWCA of North Orange County. This collaborative effort is coordinated by Ambrocia Lopez, Community Outreach and Education Manager, for this local Komen Affiliate.
This innovative outreach effort entails a designated area of the local markets, where women have direct access to mobile mammography services in their neighborhoods where they live, shop, work and play. Susan G. Komen Orange County does not provide direct service to women, but coordinates this effort through the YWCA of North Orange County. The YWCA of North Orange County contracts with mobile mammography providers to perform exams - including clinical breast exams, film interpretation, and follow-up with those who require call-backs for abnormal findings. This targeted outreach effort, utilized primarily by Latinas of Mexican descent but open to all women, is conducted in tandem with the State of California Every Woman Counts program in the area to remove all barriers to access such as the ability to screen undocumented women. About 61% of Latina women have historically been diagnosed at a later stage of detection and have higher than average rates (34% higher) of death from breast cancer.[iii] This concentrated effort, coordinated by the Orange County Affiliate, requires the resources of all involved in meeting key components of need in their community outreach awareness and education, mammography screening and follow-up, and referrals to other medical and psychosocial services within the community. The success of this program has been due to the following outreach and marketing activities.
- announcements about upcoming events on the website and direct mail pieces distributed by Northgate Gonzalez Markets
- sign-ups in front of the local markets and other locations days prior to the actual events
- ongoing social media and other communications efforts of the Komen Affiliate through its community events, lectures, and mailings.
These free mammography screening events result in about 30 appointments scheduled per site - with walk-in appointments also available. There are about six mammography screening events per year and roughly 180 women screened per year. The results from these education and screening efforts have resulted in about 30 abnormal findings per year.
Another notable example of a highly effective mobile digital mammography program has been evidenced in the regional and national outreach of Inner Images, Inc. - founded and owned by Debora Wright, an early member of NCBC and a prior member of the NCBC Board of Trustees. This well-integrated, worldwide wellness company has been making an impact since June 1988, and has since…
- established a non-profit foundation—A Vision of Health—that focuses on breast cancer prevention through lifestyle education and changes
- serves as preceptors and conducts a study called the Mammography Appointment Program (MAP) in the Masters in Public Health program at California State University, Northridge (CSUN)
- schedules numerous mammography screening events at corporations such as Google and United Airlines, grassroots organizations, women’s shelters, foundations, family health centers, clinics, and in limited access areas such as Catalina Island.
Inner Images, Inc. has witnessed excellent outcomes in mobile mammography screening: (1) 45,000 exams conducted per year; (2) A 6% call-back rate; and (3) breast cancer detection rates in line with the national American College of Radiology standards. In addition, the MAP study project, in conjunction with CSUN, has shown high rates of actual participant attendance at screening. MAP helps to reduce "no-show" rates for mammography appointments. And, students have worked with Inner Images to conduct studies to determine more effective screening and recruitment measures.
Whether the outcome is a formal research study, endorsement by ASCO, or evidence of its impact in local grassroots programs and initiatives, mobile screening mammography is reaching women and saving lives - particularly for underserved and more vulnerable populations. While the programs in this article are primarily located in southern California, similar programs can be found throughout the United States.
Breast centers would be wise to consider placement of mobile screening mammography as a primary and/or supplemental tool among its detection armamentarium in the fight to diagnose breast disease at earlier stages. Many regions with similar underserved populations are encouraged to replicate the effective screening and recruitment strategies discussed above.
For more information, please contact Marie LaFargue, MPH at MLaFargue@memorialcare.org
[i] http://meetinglibrary.asco.org/content/136837-151
[ii] American Cancer Society, Facts and Figures
[iii] Ibid.
Newsletter Committee Expansion
The NCBC Breast Center Bulletin has been the major publishing arm of the organization since 2002. With the recent recruitment of Susan Casella, RN, OCN and Rufus Mark, MD as the Co-Editors and the promotion of Claudia Z. Lee, MBA to Editor Emeritus, the Newsletter Committee is being expanded to spread the membership representation. We have several new members and are seeking additional members to complement the existing core and to fill vacancies within the Organizational Chart below.
The 11 sub-committees are divided by topic and consist of the following categories.
- Diagnostics
- Financial
- Genetics
- Marketing
- Nursing
- Resources
- Survivorship
- Technology
- Treatment
- Underserved
As one can see from the Organizational Chart below, we need members to Chair the Sub-Committees for [1] administration, [2] genetics, [3] treatment, and [4] underserved populations.
The role of each chair is to work with the members of the sub-committee to identify potential topics and authors and submit to Dara Long [dara@breastcare.org] who will refer to the Newsletter Advisory Board for consideration. Sometimes, there will be topics identified with no author mentioned and that is fine as others may be able to identify an appropriate author.
The time commitment is minimal. The first communication within the sub-committee is usually by a short conference call for introductions and discussion of goals if possible – with most, if not all, future communication is by email.
In addition to Sub-Committee Chairs, we need members to participate in two Sub-Committees [1] Economics and [2] Resources.
- Economics addresses the financial viability of the Breast Centers such as issues related to billing, coding, ROIs, cost savings interventions, etc.
- Resources addresses the fine tuning, updating and expansion of the Resource Directory that is already posted on the NCBC website. One planned expansion is the state-specific resources.
It is important to know that members of the newsletter Committee can provide input to any sub-committee, not just the principal one identified in the Organizational Chart.
Newsletter Committee Organizational Chart
| Editors: Susan Casella, RN, OCN & Rufus Mark, MD |
| Editor Emeritus: Claudia Z. Lee, MBA |
| Advisory Board: Sue Bowman, RN, OCN, CBCN, MSW, Marie LaFargue, MPHBarbara Rabinowitz, PhD, MSW, RN & Deb Kirkland, RN, BSN, MPH, CN-BN |
| Administration | E. Bridgette Hearne, RT(R)(M)(BD)(QM), CN-BM | EHearne@fmh.org |
| Andrew Newman | anewman@ommi.net | |
| Kelly J. Hall, MBA | khall@informeddna.com | |
| Nicholas DeLapo | ndelapo@PINNACLEHEALTH.org | |
| DiagnosticsShahla Masood, MD, FCAP, MIACshahla.masood@jax.ufl.edu | Babak Behnam Azad | bbehnam1@jhmi.edu |
| Jeffrey Mueller | Jeffrey.Mueller@uchospitals.edu | |
| Ruth Smith | Ruth.smith@carolinashealthcare.org | |
| EconomicsGerald Kolb, JDgerald.kolb@breastgroup.com | ||
| GeneticsConnie Roche, MSN, ANP-BC,OCN,APNGcroche@partners.org | Linda Smith | hunterdenali@icloud.com |
| Karen Herold, DNP, FNP-BC, WHCNP-BC | karen.herold@hoag.org | |
| Maria Palafox, MD | maria.palafox@aol.com | |
| Kelly J. Hall, MBA | khall@informeddna.com | |
| MarketingMarie LaFargue, MPHlafargue.marie@yahoo.com | Beth Phelps, BS R. T. (R)(M) | bphelps@houstonmethodist.org |
| NursingSue Bowman, RN, OCN, CBCN, MSWsbowman2@wellspan.org | Jennifer Glover, RN, MS, CBCN | gloverj2@pamf.org |
| Janell Clark, APN-BC, MSN, MBA | Janell.Clark@ctca-hope.com | |
| Bobbie Perrin, RN, OCN, CN-BN | bperrin@harringtoncc.org | |
| Ruth Smith, RN, BSN, MSN | Ruth.smith@carolinashealthcare.org | |
| ResourcesDeb Kirkland, RN, BSN, MPH, CBPN-ICdkirklan@lifebridgehealth.org | ||
| SurvivorshipBarbara Rabinowitz, PhD, MSW, RNbrphd@aol.com | Julie Shisler, CBPN-IC | jshisler@windsongradiology.com |
| Maria Palafox, MD | maria.palafox@aol.com | |
| Pat O'Brien APRN, NP-C | pat.obrien@midhosp.org | |
| TechnologyLorraine Tafra, MD, FACSltafra@aahs.org | Joan Berry, RT(R)(M) | berryjo@exempla.org |
| E. Bridgette Hearne, RT(R)(M)(BD)(QM), CN-BM | EHearne@fmh.org | |
| Jeffrey Mueller | Jeffrey.Mueller@uchospitals.edu | |
| Babak Behnam Azad | bbehnam1@jhmi.edu | |
| Melanie Leach RT (M) | MLeach@memorialcare.org | |
| Treatment | Mauricio Costa | mamcosta@yahoo.com |
| Underserved | Kathy Dittmar, RT(R)(M) | kathy.dittmar@palimomi |
| Joan Berry, RT(R)(M) | berryjo@exempla.org | |
| Agnes Musonda | agnesmwela@gmail.com | |
| Maria Palafox, MD | maria.palafox@aol.com | |
| Janell Clark, APN-BC, MSN, MBA | Janell.Clark@ctca-hope.com | |
| Gail Greenburg | gegreenburg@mercy.com | |
| Bobbie Perrin, RN, OCN, CN-BN | bperrin@harringtoncc.org | |
| Unassigned | Deborah J Wells RT, R, M, ARRT, ASRT, NHSRT | insky.fortynine@gmail.com |
| Laura Pearson, MD FACS | lpearson@nasasurgeryatl.com | |
| Cara Kondaki, LCSW,ACSW, CBPN-IC, OSW-C-Oncology/Social Network | KONDAKC@ccf.org |