Mayor William E. Ward

Chesapeake is a progressive city with a population of approximately 200,000 that is comprised of 27 percent minorities. The city is growing at a very high rate with a dramatic 33 percent population increase during the past decade, resulting in a high demand for medical services, especially for low-income and older citizens. Chesapeake, under the leadership of Mayor William Ward, is very interested in the health, welfare, and safety of all its citizenry.

The core functions of public health in the State of Virginia are health assessment, policy development, and assurance. The most common and effective public health activities are in the area of primary prevention, which has two main components: health promotion and health protection. In support of these components, the Chesapeake Health Department conducted a 1995 needs assessment to determine the status of breast and cervical cancer among women in Chesapeake. Mayor Ward gave his strong endorsement to the efforts of the health department, which is an integral part of the city.

Assessment Places African Americans at Special Risk

Overall, the assessment revealed that screening services for uninsured, and/or low-income women were insufficient. Awareness and educational programs were very limited. Barriers to women getting early detection screening included cost, fear of discomfort, not understanding the need for screening, transportation problems, and - - especially - - lack of awareness of services.

The findings for older African American females were alarming. This group had three times the mortality rate for breast cancer than reported in state statistics for all African American women, as well as three times the mortality rate of Caucasian women. Other findings that related to the special needs of African American women follow.

• Breast cancers in black women were detected at a later stage and were more aggressive, leading to higher mortality rates.
• Black women developed the disease at a younger age than white women.
• Breast cancer was the leading cause of cancer death among African American women between the ages of 30 and 54.

Findings Result in Plan for Outreach

A plan was developed to promote public awareness and education to the entire population of Chesapeake, but targeted to low-income women, particularly minorities. A coalition of appropriate key leaders, health and community organizations, churches, and citizens was formed to increase public awareness of the need for early detection of breast cancer through breast self-exam, physician/nurse examinations, and, especially, mammography screening. The result was a Breast Cancer Awareness Campaign that reached deeply into the community.

Churches

Churches served as the sites for reaching the largest number of women. Because of the influence that ministers’ wives have on both their husbands and church members, a luncheon and educational program was held to elicit their support for outreach to women in their congregations and the community. Schedules for screening and educational presentations were included in church bulletins and distributed during church meetings. Several church representatives were instructed in the "Art of Breast Self-Examination" for the purpose of training other women in their congregations and the community, thereby creating a multiplier effect and reaching larger numbers of women.

Community Network

Members of the outreach coalition serve on various boards, committees, and other coalitions. They promote awareness and provide information for their colleagues to distribute. For example, the coalition member representing the National Council of Negro Women made sure that breast cancer flyers were distributed to local beauty salons. Several coalition members serve on the "Minority Health Coalition of South Hampton Roads" that addresses all aspects of health for minority women. Coalition members have also appeared on television and radio to address issues of breast cancer awareness.

Community organizations and the media also helped. Senior housing developments, social service departments, and senior centers made awareness information available to their respective residents and clients. YWCA volunteers provided transportation to doctors offices and screening sites. The daily newspaper included an eight-page insert on breast cancer awareness.

Use of Events and Incentives

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

Outcome Includes Treatment

The effectiveness of these outreach efforts has been evidenced through greater demand for screening. In response, area mammography centers - - including a mobile van - - donated free mammograms for eligible women, as identified by the health department. However, it is not enough to provide screening for women unless treatment referrals also can be made for those who are diagnosed.

In response to the concern about providing treatment, the most exciting and extensive outcome of the Breast Cancer Awareness Campaign was the public-private partnership established between the Chesapeake Health Department and Chesapeake General Hospital. Not only were free mammograms offered to eligible women, but thirteen surgeons, one oncologist, and one radiologist agreed to donate treatment services as needed.

The relationship with Chesapeake General Hospital has dramatically increased the city’s marketing efforts to all the women in the community. In a three-month period, seventy-six women were screened, five biopsies were performed, and three diagnosed women are being treated. All those involved in the Breast Cancer Awareness Campaign believe that the outreach strategies employed have saved these three lives.

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

Future Plans

Future strategies include producing hand fans, imprinted with a message about free mammograms,  for women to use in church.

Contact: Rhoda Stillman, Breast/Cervical Cancer Coordinator, Chesapeake Health Department, 757/382-8710

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The United States Conference of Mayors

J. Thomas Cochran, Executive Director
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