Mayor Carlos M. Ramirez

In the summer of 1997 Mayor Carlos Ramirez and the city council recognized the need to improve screening services for the early detection and prevention of breast cancer. This need was underscored by the fact that a high percentage of El Paso citizens live in low socioeconomic communities and cannot afford the cost of preventive health care. Too often a woman is diagnosed in the later stages of breast cancer when treatment is costly and less effective. Today, however, due to the actions of the mayor and the city council, El Paso women with limited family income have access to early breast cancer screening services.

Creating a Structure for Outreach and Screening

Realizing that a formal program would ensure success, in September 1997 Mayor Ramirez and the El Paso City Council provided funds to the City-County Health and Environmental District to establish a Cancer Screening Program. In addition to committing Community Development Block Grant funds to the initiative, the city augmented the program with general fund monies. In the area of breast cancer, the program goals were to provide the following services to underserved El Paso women:

• clinical examinations;
• individual breast self-examination instruction; and
• client referral to the local county hos-pital for screening mammography (the Texas Tech Medical Center and Thomason General Hospital).

Just one month after funds were provided for the initiative, the health district’s Westside Health Center scheduled the first clients for screening appointments. Building upon this success, the health district in November enlisted the local mass media to help raise awareness and increase program participation. Promotional visits were also made to local businesses, shopping centers, and schools. Flyers went to local factories, the community college, federal housing projects, churches, and senior citizen centers.

Expanding Outreach

By December, the health district was able to reach out to special populations by extending screening services, with emphasis upon breast cancer, to the city’s shelter for battered women. A bus transported women from the shelter to the Westside Health Center where the newly formed cancer screening team - - consisting of a registered nurse, medical aide, and clerk - - was based. In addition, and for the first time, breast cancer screening was provided to residents of small towns within the county.

Three months later, screening services were extended throughout the city. Beginning in March 1998, other community health centers became screening sites through the visits of the cancer screening team. As women with transportation problems found that they could access breast cancer screening services in their own neighborhoods, the number of monthly visits to the health centers increased. However, mammography was still provided in only one location, the county hospital.

Coordination for Neighborhood Mammography

Soon the health district realized that mammography screening should be neighborhood-based also and, during July 1998, entered into an agreement with the Texas Tech Medical Center for this purpose. Accordingly, the University Breast Care Van visited four community health centers to offer mammography. These centers scheduled appointments for clinical breast cancer exams to coincide with the van’s arrival. Therefore, women needing mammograms no longer had to seek appointments in two different sites because all screening services were available in their respective neighborhoods. The Komen Foundation supported the mammograms for underserved women through funds raised during its yearly "Race for the Cure" event. The women who qualified for this support were low- income, underinsured and uninsured.

Program Outcomes

From September 1997 to June 1998, 846 women received clinical examinations at four community health centers. One measure of success is the identification of cancer in its earlier stages when treatment can be more effective. From March 1 to May 31, 1998, ninety-three women were provided clinical breast screening at the health district’s Rawlings Community Health Center, centrally located in El Paso. Four women had abnormal clinical breast screening and were referred for diagnostic mammography. Two of these women were diagnosed with breast cancer which resulted in surgical removal of the breast and appropriate follow-up care.

Future Plans

Mayor Ramirez and the city council have ensured funding to support the cancer screening program for the coming year. The mayor promoted outreach in the city’s involvement in the "Pink Ribbon Wreath Ceremony" and "National Breast Cancer Awareness Month" in October - - events that were widely covered in the mass media. With the mayor’s active leadership, the city will continue to emphasize early breast cancer detection, treatment, and successful outcomes for the women of El Paso.

Contact: Jorge C. Magana, M.D., F.A.A.P., Director, El Paso City-County Health and Environmental District, 915/771-5701.

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The United States Conference of Mayors

J. Thomas Cochran, Executive Director
1620 Eye Street, NW, Washington, DC 20006
Telephone (202) 293-7330, FAX (202) 293-2352

Copyright ©1996, U.S. Conference of Mayors, All rights reserved.