CITY OF BOSTON, MA
Mayor Thomas M. Menino

Mayor's Cancer Screening Initiative Includes "Breast Friends" Program

Mayor Thomas Menino has taken on the fight against cancer with great commitment and vision, showing what can be accomplished when a mayor addresses a major public health problem through community-based services. Since 1994, the city. s public health agencies under the direction of the mayor have developed a number of effective community-based cancer screening programs.

Because breast cancer is both the leading cause of cancer death and disproportionately affects women of African descent, the Breast Friends Program of the Boston Public Health Commission (PHC) was created to increase awareness of the importance of breast cancer screening and early detection services. Last year, the mayor and the PHC initiated a cancer outreach program and purchased two state-of-the-art vans to perform prevention education and mammography screening in Boston. s diverse neighborhoods.

The mayor has also carried his commitment to cancer awareness to city hall by allowing each city employee four hours of release time from work to obtain cancer screening. This action alone has saved the lives of at least two city employees - - one who was diagnosed with breast cancer - - and promises to save many more.

Breast Friends Program

The Breast Friends Program is designed to convince women to be proactive with their own health and to give them the resources and information needed to make better choices for themselves and their families. The Program targets all women, but focuses particularly on those who are economically disadvantaged, underinsured, and of color. The three components of the program are: 1) training community women to be outreach workers and workshop facilitators about breast health and to refer women to mammography; 2) outreach to the neighborhoods of Boston through breast health workshops, health fairs, mammogram van sites and other community activities; and 3) information, referral, and follow-up, including dissemination of educational materials and referral of women to health care resources when necessary.

Program Strategy through Parties

The major activity of the program is the hosting of "Breast Friends Parties." These parties are conducted by women from the community who have been trained as facilitators. Party leaders are recruited from health centers, churches, women. s shelters, housing developments, and other community-based agencies, as well as by word-of-mouth. Using peers as facilitators is an effective means of reinforcing positive breast health messages and to break down cultural barriers around breast care.

Training

Party leaders attend a one-day comprehensive training session on breast health and begin setting up a party schedule. They then recruit women from their own circle of contacts to host the parties/ workshops or have sessions assigned to them. A party leader is paid a stipend of $50 per party, $17 for refreshments, and $10 toward a party baby-sitter if necessary. The program will provide free taxi cab vouchers to leaders who need them.

Outreach

The outreach component of the program has been designed to address the cultural and linguistic barriers that prevent women from discussing their breast care. The strategy uses existing networks of family, friends, and co-workers. The "Breast Friends Parties" have a unique way of reaching neighborhood women by providing a safe and supportive setting for women to talk about strategies to detect breast cancer at an early stage and learn where to seek help if necessary.

The parties have been conducted in women. s homes, churches, health centers, senior organizations, schools or in other places where intimate surroundings make women comfortable in relating to one another. These parties/workshops teach women about basic breast health and early detection methods, such as breast self-examinations, clinical breast examinations, and yearly mammography.

Women who attend workshops are provided "goodie" bags containing educational materials and party favors. Women who receive a mammogram through the program receive gift certificates or other incentives to reinforce program participation. Hosts of Breast Friends Parties are given a program T-shirt or canvas bags. Breast Friends Parties are informative and fun - - and they are taking Boston by storm.

Information, Referral and Follow-up

Two patient ambassador positions were created at the PHC to provide support to trained facilitators and hosts. The patient ambassadors provide tracking of the party participants and assist the facilitators in identifying resources to help women complete their mammograms. Usually, several telephone calls are made or letters sent to the workshop attendees to encourage them to schedule a mammogram. The ambassador can set up the appointment, accompany a women to the mammogram, provide an interpreter, and give a taxi voucher for transportation. A woman can choose to receive her free mammogram at one of fourteen designated screening sites.

Impact of Breast Friends

To date, the Breast Friends Program is proud of the following successes:

• Ninety-one community women have been trained to facilitate Breast Friends Parties in Boston.
• Eighty percent of party participants eligible for a mammogram under went mammography after attending a Breast Friends Party.
• One hundred twenty Breast Friends Parties have been conducted through-out the neighborhoods of Boston, reaching more than 1,000 participants.
• A culturally-relevant and linguistically- appropriate training curriculum has been developed for Breast Friends Party Leaders.
• Over 5,000 educational materials for women on breast cancer early detection have been distributed in English, Spanish, Haitian Creole, and Vietnamese.
• Women trained to facilitate parties significantly increased their post-test breast cancer knowledge and awareness of breast cancer early detection methods.
• Technical assistance was provided to over 100 organizations.

Breast Cancer Diagnosis

The Breast Friends Program provided screening referrals as follows:

• 195 mammograms in 1997; and
• 212 mammograms to date in 1998.

Since 1995:

• 25 women were diagnosed with breast cancer.
• 50 biopsies were performed.

All of the 25 diagnosed women were referred for and received appropriate treatment.

Follow-up was conducted for ten of these women, revealing that:

• 3 mastectomies were performed.
• 6 lumpectomies were performed.
• 1 recurrence occurred.

The Family Van and Mammography Van

Through Mayor Menino. s leadership, the city has funded two state-of-the-art community health vans - - one to provide mammography services and the other to deliver prevention information services to all of the diverse neighborhoods of Boston. The Mammography Van will provide: 1) screening mammograms for women in their own neighborhoods; 2) health insurance information; and 3) referral to sources of follow-up care. The Family Van will provide a range of services to men, women

and children, focusing on access to health care and dissemination of cancer prevention information. Both vans will work in close partnership with the city. s community health centers and the programs of the PHC to ensure access to breast cancer prevention services and general health services for all of the women in Boston.

Contact: John Auerbach, Executive Director, Boston Public Health Commission, 617/534-5395

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