Mayor Clarence Harmon

As a means of bringing health information, education, and cancer screening to those women in Missouri who are least likely to obtain health care, a statewide partnership has been formed that carries the motto "Keeping Women Healthy." Known as the Breast and Cervical Cancer Control Project (BCCCP), the partners are:

• Centers for Disease Control and Prevention;
• Missouri Department of Health;
• St. Louis City Department of Health;
• American Cancer Society;
• local health care providers (13 of which are in the St. Louis area); and
• dedicated volunteers.

Mayor Clarence Harmon has given full support to the involvement of the St. Louis City Health Department in BCCCP, an effort that seeks to educate all women about breast cancer and to increase the length and quality of their lives by making screening services available. Following are outreach strategies implemented in the St. Louis area for priority populations.

Using the Media and Community Events

BCCCP’s Public Education Component places ads in "specialty" newspapers and directory publications serving the African American female and aging communities. As funds allow, ads are also aired over broadcast and cable TV outlets in the city at preferred viewing times and on programs that reach BCCCP-eligible women. BCCCP health care providers receive posters, brochures, and fact sheets for display and distribution. BCCCP ads appear inside and outside public transit buses in St. Louis. Church-based outreach efforts, called "Pink Ribbon" campaigns, have placed BCCCP literature in the hands of thousands of St. Louis women. BCCCP staff distribute project materials at several important St. Louis exhibitions each year, including National Aging Conferences, the Working Women’s Survival Show, Sister-to-Sister Expo, and the Missouri Black Expo.

Enlisting the Aid of Local Health Care Coalitions

BCCCP’s Coalition Component works with two St. Louis health care coalitions to recruit area women for breast and cervical cancer screening. An annual calendar, featuring photos of members of the two coalitions, serves as a major screening recruitment tool because it includes information on breast and cervical health in both English and Spanish. In addition to holding training sessions on outreach and recruitment strategies, BCCCP also assists members of the health care coalitions to pursue grants and leadership training opportunities. In return, members of the health care coalitions have been active in the Pink Ribbon campaigns and in staffing BCCCP exhibits.

Follow-up on Abnormal Results

BCCCP Site Coordinators staff the Follow-Up Component in the St. Louis area. Acting on referrals from BCCCP screening providers, they contact clients who have received abnormal screening results to make sure these women comprehend and understand these findings as well as the need to pursue a final diagnosis. Site coordinators solicit up to five contacts with clients - - by telephone, written communication, and home visitation - - to reschedule appointments and encourage compliance. In addition, they give regular presentations in the St. Louis area on breast and cervical health and explain the logistics of the program.

Welfare Recipients as Outreach Workers

In 1996 BCCCP conducted a unique outreach and recruitment project in the City of St. Louis, one that continues to pay dividends for women throughout Missouri. Welfare recipients were employed as outreach workers in the North St. Louis area, interviewing neighbors about their knowledge of cancer screening and, when appropriate, recruiting them for the program. The Washington University School of Social Work provided supervision and training for the new outreach workers, who were headquartered in the Prince Hall Family Support Center, a well-known St. Louis social service agency.

As a result of the welfare workers’ presence in this key community agency, additional women from the pilot neighborhood appeared at the Center, coming as walk-ins with questions about breast and cervical cancers. The success of this 1996 St. Louis outreach project led directly to a similar program in 14 rural Missouri counties in 1998. Both the Missouri Department of Health and the Department of Social Services hope for further expansion of this initiative in the future.

Outreach Outcome

Statistics complete the picture of BCCCP’s outreach, recruitment, and follow-up activities in the St. Louis area. The project has provided breast and/or cervical cancer screenings for 8,200 St. Louis women, over 80 percent of whom are African American. Fully 40 percent had not graduated from high school. Almost 98 percent of BCCCP clinical breast exams yielded normal results, and just over 94 percent of mammograms had negative results. BCCCP’s St. Louis area health care providers have diagnosed twenty-two cases of breast cancer during the project’s life to date, and all have received appropriate follow-up.

Contact: Larry E. Fields, MD, MBA, Director/Commissioner, St. Louis City Health Department, 314/658-1140.

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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.