Chesapeake Health Assessment Leads to Greater Breast Cancer Awareness for Minorities

In the State of Virginia, most public health activities are in the area of primary prevention, an area in which the two main components are health promotion and health protection. In 1995, as part of its promotion and protection mission, and with the endorsement of Mayor William E. Ward, the Chesapeake Health Department conducted a needs assessment which focused on breast and cervical cancer among women in the City. The results showed some serious problems.

Minorities comprise 27 percent of Chesapeake's approximately 200,000 residents. The City's rapid growth -- a 33 percent population increase during the past decade -- has created a high demand for medical services, especially among low-income and older citizens. It was not surprising, therefore, when the assessment revealed that breast cancer screening services for uninsured and/or low-income women were insufficient, and that awareness and education programs were limited. Beyond the greatest problem -- lack of awareness of the services available -- barriers to women getting early detection screening included cost concerns, fear of discomfort, lack of understanding of the need for screening, and transportation problems.

Minorities Face Special Risks

For Chesapeake's older African American females, the findings were alarming: As a group, they experienced three times the breast cancer mortality rate shown in State statistics for all African American women, and three times the mortality rate for Caucasian women as well. Other findings that related to the special problems and needs of African American women included the fact that breast cancers in black women were detected at a later stage and were more aggressive, leading to higher mortality rates; that black women developed the disease at a younger age than white women; and that breast cancer was the leading cause of cancer death among African American women between the ages of 30 and 54.

Outreach Plan Targets Minorities

The plan developed by the City called for public awareness and education across the entire population of Chesapeake, but was targeted to low-income women, particularly minorities. As part of the plan, key leaders from government, health and community organizations and churches joined citizens in a coalition to increase public awareness of the need for early detection of breast cancer through breast self-examinations, physician/nurse examinations and, especially, mammography screening. The Breast Cancer Awareness Campaign which was produced reached deep into the community.

Churches - Churches were the sites through which the largest number of women could be reached. Because of the influence that ministers' wives have on their husbands and on church members, a luncheon and education program was held for them, to elicit their support for outreach to women in their congregations and in the larger community. Schedules for screenings and educational presentations were included in church bulletins and distributed during church meetings. Several church representatives were instructed in breast self-examination so that they could train other women in their congregations and in the community, creating a multiplier effect and reaching larger numbers of women. In addition, Chesapeake General Hospital has produced hand fans imprinted with information on free mammograms for use in the churches.

Community Network - Members of the outreach coalition serve on various boards and committees, and on other coalitions. Through their positions they promote awareness in a variety of ways, including providing information for their colleagues to distribute. One coalition member, for example, made sure that breast cancer flyers were distributed to local beauty salons. Several members serve on the Minority Health Coalition of South Hampton Roads, an organization that addresses all aspects of health for minority women. Coalition members also have appeared on television and radio to address breast cancer awareness issues. Throughout the community, senior housing developments, social service departments and senior centers have made awareness information available to their residents and clients. YWCA volunteers have provided transportation to doctors' offices and screening sites. The daily newspaper included an eight-page insert on breast cancer awareness.

Events and Incentives - Posters, awareness materials and screening information have been distributed during health department clinics, health fairs, community and sorority meetings, luncheons, and at senior centers. On Mother's Day, cards reminding women to get mammograms were distributed. Women who attended educational programs were given "goody bags" filled with promotional items, and those who received screening also were given a number of gifts. A candle-lighting service designed to promote awareness and early detection was held for breast cancer survivors.

Outreach and Treatment Linked

The effectiveness of Chesapeake's outreach efforts has been reflected in an increased demand for screening, and area mammography centers -- including a mobile van -- have responded by providing free mammograms for eligible women who are identified by the Health Department. Officials know, however, that it is not enough to provide screening for women; referrals for treatment, when diagnosis indicates a need, also must be made. In their view, the most exciting and valuable outcome of the Breast Cancer Awareness Campaign is the public-private partnership established between the Chesapeake Health Department and Chesapeake General Hospital. Through this partnership, free mammograms are provided eligible women, and 13 surgeons, one oncologist and one radiologist are donating treatment services as needed.

The relationship with Chesapeake General Hospital has had the effect of dramatically increasing the City's outreach to all women in the community. In a three-month period, 76 women were screened, five biopsies were performed, and three diagnosed women were being treated. All involved in the Breast Cancer Awareness Campaign believe that the outreach strategies employed have saved the lives of the three women in treatment.

A grant application submitted by Chesapeake General Hospital to the Virginia State Health Department, for federal funds to pay for mammograms and pap tests for eligible women, resulted in the award of a $33,000 grant to expand the screening opportunities available to the women of Chesapeake.

"Breast cancer is a leading killer of women," says Mayor Ward, "and early detection is essential. I wholeheartedly support this Breast Cancer Awareness Campaign and endorse its goal of educating the public about mammograms as a means of early detection."

Additional information on Chesapeake's initiative is available from Rhoda Stillman, the Breast/Cervical Cancer Coordinator for the Chesapeake Health Department, at (757) 382-8710.

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