Addressing Care gap in underserved women not
easy
Newswise — In an effort to fill a
significant gap in the breast care of
underserved women, physicians and nurses at
Mayo Clinic’s campus in Jacksonville, Fla.,
developed a program, still ongoing, to help
overcome barriers that prevent women from
receiving timely care after an abnormal
mammogram.
From 2001 through 2006, Mayo Clinic’s
Multidisciplinary Breast Clinic offered free
diagnosis services to 447 women who had been
screened for breast cancer by their county
health departments in Northeast Florida.
The goal was to substantially reduce what
can be a long delay between an abnormal
screening mammogram and diagnosis — which
they succeeded in doing — and thus improve
outcomes for the 38 women found to have
cancer and reduce distress in many others.
Arriving at a correct diagnosis was
relatively easy; overcoming the barriers to
health care that many women have was not,
says the lead author and researcher
presenting an analysis of the program at the
annual San Antonio Breast Cancer Symposium
meeting.
For example, many women participating in the
program had no address, or just a temporary
one, such as a battered women’s shelter,
says Frances M. Palmieri, M.S.N., clinical
manager of the Multidisciplinary Breast
Clinic. Few had telephones, public
transportation to the clinic was
nonexistent, and some women were reluctant
to come in any case, Palmieri says. Others
could not take time away from child care or
work to come to the clinic for evaluation.
“This is a snapshot of what happens
nationally to financially disadvantaged,
medically uninsured women,” she says. “We
all need to understand and try to overcome
the challenges and barriers to patient care
that exist for many.”
Among other things, the Breast Clinic worked
with local charities to provide clothing to
those who needed it, and worked with the
city of Jacksonville to have the public bus
service stop at the clinic. They assigned a
research nurse, Judith Smith, to help find
and bring women into the clinic, which
quickly emerged into a full-time pursuit.
“It is important that women undergo
appropriate diagnostic studies as soon as
they receive an abnormal breast cancer
screening, but it takes much more
coordination than we ever expected,”
Palmieri says.
Several programs exist nationally to provide
free breast cancer screening mammograms to
underserved women, but there is no unified
system for providing diagnostic services
when abnormalities on the mammograms are
detected.
As a result, in late 2000, Mayo
Clinic in Jacksonville and Betty Anne Mincey,
M.D., who was at Mayo at the time,
instituted a program to address this gap in
care. The Breast Clinic worked with health
departments in four counties surrounding the
institution (Nassau, Duval, St. Johns and
Clay), so that women with abnormal
mammograms would be referred to Mayo Clinic
for a diagnosis.
A team of radiologists, led
by Elizabeth DePeri, M.D., current principal
investigator of the study, worked to provide
flexible procedure times and overcome system
barriers to offer a timely review of
screening films and a rapid diagnosis.
Of the 447 women enrolled through 2006, 65
percent were white, 21 percent were black,
and 11 percent were Hispanic. The mean age
was 49.7 years. Physicians performed 893
procedures (mostly diagnostic mammograms and
ultrasound tests) and found that 90 percent
of the abnormalities detected on initial
mammograms were benign.
They also diagnosed
38 cancers, of which 76 percent were
invasive carcinoma that needed immediate
treatment. In most cases, county health
departments provided that treatment, but
some patients were cared for at Mayo Clinic.
No data is available yet on outcomes.
The clinic succeeded in reducing what had
been a typical delay of several months down
to an average of 36 days, well below the
60-day benchmark established by the U.S.
Centers for Disease Control and Prevention
(CDC), Palmieri says.
“This has been a real education for all of
us, but our study demonstrates that timely
diagnostic resolution of abnormal mammograms
in low socioeconomic status women is
achievable with a coordinated, collaborative
program between an academic medical center
and public health departments,” she says.
Edith A. Perez, M.D., is the senior
investigator for this initiative. The
program was supported by grants from the
Susan G. Komen Foundation, the National
Breast Cancer Foundation, Pfizer Oncology,
Bristol-Myers Squibb, Sanofi-Aventis, Breast
Cancer Research Foundation and Mayo Clinic.
