Healing underserved women
African American health pros and their patients build trust to save lives from breast cancer
On a cool, overcast day in early December, Frances “Frankie” Scott, 69, of Penn Hills, recalled her life back in the fall of 2018, before she had surgery for breast cancer.
The recent Thanksgiving holiday had been especially meaningful, she said.
“I was so thankful I was here this year, able to be thankful,” she said.
The whole thing had started with a notice on Facebook inviting African American women to a breast cancer program at UPMC Magee-Womens Hospital — offering free mammograms, food and information.
Ms. Scott took it as a sign that she needed to get a mammogram, something she had put off for about five years.
“I felt fine. I was busy with kids,” she said, even though she had noticed a thickening in the right breast for some time.
The fact that she felt a nudge was no accident. Ms. Scott was responding to an intentional effort to persuade more African American women to get screening and then to get treatment.
According to the U.S. Centers for Disease Control and Prevention, African American and white women get breast cancer at about the same rate, but African American women die from the disease at a rate 40% higher.
For more than a year now, Pittsburgh-area health care professionals have been reaching out to African American women in McKeesport to improve the breast cancer survival rate. And the pros are a team of primarily African American providers — adding cultural and racial connections to the effort.
Steven Evans, a Hillman Cancer Center surgical oncologist, leads the UPMC team of specialists and local pastors holding town hall meetings in McKeesport and programs at churches and community centers. As part of the approach, Hillman and Magee distribute brochures targeted to African American women and emphasizing the importance of early detection.
“Two years ago, there was no cohesive center that focused on this education to eliminate disparities in outcomes in African American women,” Dr. Evans said.
Over time, UPMC has found collaborators and stakeholders to make the idea a reality.
“Everything we wanted to happen is happening,” Dr. Evans said, adding that he applies the African proverb: “If you want to go fast, go alone. If you want to go far, go with others.”
A community push
Partners in the effort include the McKeesport pastors’ call-to-action committee, elected officials, the school district, nurses’ groups and other agencies such as the American Cancer Society and the Cancer Caring Center.
Outreach by Oakland and Shadyside hospitals is important, Dr. Evans said, “because culturally in Pittsburgh, people don’t cross bridges.” Transportation and insurance problems are barriers to good health care.
“We chose McKeesport because of the socioeconomic disparity there,” he said. “The first thing we talk about is financial.”
Funds for breast and cervical cancer screening and diagnostic services are available for low-income, uninsured and underserved women through the National Breast and Cervical Cancer Early Detection Program. A staff person, Lindsay Hermann, helps patients coordinate their needs at UPMC’s Latterman Family Health Center in McKeesport, where Dr. Tracey Conti sees patients.
African American leaders on the breast cancer team include LaJuana Fuller, director of women’s imaging at Magee, and Dawndra Jones, chief nursing officer at UPMC East and McKeesport hospitals.
University of Pittsburgh researchers already have been working in the community to discover barriers to care and how to overcome them.
“The problem is women don’t know the importance of getting mammograms,” Ms. Fuller said. “I want them to know they should get their mammogram, get it taken care of and don’t worry about insurance.”
At church events, a pastor’s support builds trust, she said. Breast cancer survivors also tell their stories, including women admitting they had delayed their mammograms.
“I think often life gets in the way, undergirded by fear,” Ms. Fuller said.
Ms. Scott said that’s how she felt: “I didn’t want to die. The main thing was the fear of the unknown.”
When she called to sign up for the Magee event, Ms. Scott spoke with Ms. Fuller, but she didn’t know she was talking to the boss. She was just happy to get a friendly, quick and thorough response — she was told the thickened tissue indicated it might be serious.
“She gave me the complete mammogram treatment,” Ms. Scott said. “It actually saved my life.”
The screening on July 28, 2018, led to a March 18, 2019, mastectomy, with no need for radiation or chemotherapy. Cancer-free as of Aug. 7, Ms. Scott also has recovered from reconstructive surgery done Oct. 8.
She now takes a medication to lower the production of estrogen in her body to prevent future cancer. “I’m feeling great,” she said.
‘Get your mammogram’
Unless their personal history shows a higher risk, women need to get their baseline mammogram at age 40, Ms. Fuller said.
“Know your bodies,” she said she tells everyone, including men and younger women.
Mammograms have become more comfortable, Ms. Fuller said, with the new “smart curve” machines.
“Don’t be afraid to get your mammogram. If you get cancer, we will get you through it,” she said.
Early on, it was decided that a UPMC surgical oncologist would come to McKeesport twice a month. Dr. Evans said he now has patients diagnosed with breast cancer first seen in that office.
When African American patients see doctors, nurses and radiologists who look more like them, he said, it puts them at ease.
Pitt researchers Lyn Robertson and Peg Rosenzweig first took their message to nail and hair salons. The researchers added a McKeesport pizza shop — with mammogram information pasted onto the pizza boxes — and then more shops joined the outreach.
“I have to engage the women, do a risk assessment,” Ms. Robertson said. “It’s a one-stop shop. A woman comes to us with questions about breast, cervical and colorectal cancer screening. If they need it, we can take them, get them access, send them to the imaging services.”
She said the effort has brought higher rates of completing needed care. Four retired racial-minority nurses serve as ambassadors to meet, greet and follow up with patients at Hillman and Magee.
Ms. Robertson said her research uses a model in McKeesport and Braddock developed under the Breast Cancer Coalition in Allegheny County. For at least five years, the coalition has been addressing breast cancer mortality in Penn Hills, the Hill District, McKeesport and Braddock.
After six months of education and outreach in McKeesport and Braddock, there has been a 25% increase in mammograms, she said. Patients are followed if they go on to surgery and treatment.
“You hope by establishing good contacts, the survivors will spread the word and take the next person,” Ms. Robertson said. “Once you get that trust, that’s where you get sustainability.”
In the churches
After connecting with McKeesport churches, Dr. Evans gave a presentation in October at Bethlehem Baptist Church, where the Rev. Earlene Coleman is pastor. The pastor said she has gotten an education about the risks of breast cancer.
“I thought a mammogram was to find something, but no, they’re trying to make sure you’re OK,” she said.
She said Dr. Evans related the breast cancer theme to passages in the Bible.
“He was excellent,” the pastor said.
Shortly afterward, a woman who heard Dr. Evans speak was diagnosed with cancer and contacted him. He became her surgeon.
Rev. Coleman said the doctor told her, “I think God sent me out there for her.”
She herself had a mammogram and a follow-up biopsy in 2019.
“Everything was fine,” she said. “That lifts you and makes you feel better.”
Rev. Coleman recently participated in making a new video for the pastors’ outreach. “The word ‘cancer’ in the African American culture, that says ‘death,’” she said. “It’s not death anymore.”
She said having African American images and voices makes the message more effective.
“The faces in advertising, the faces that are speaking, that are reaching out, are the same as theirs,” Rev. Coleman said. “Sometimes in the African American community, you don’t feel the white community understands.”
In the future
Most recently, Dr. Evans, UPMC and the churches formed a call-to-action team funded by the Beckwith Institute to increase the rate of African American women getting mammograms. The institute is a fund of UPMC that supports innovative health care projects.
In 2019, this project was called Faith Based Call to Action and was granted $10,000; this year, it’s called Power of the Pulpit and is funded with $20,000 to the Rev. Shawn
Kirkland from McKeesport.
Ms. Jones, the UPMC East and McKeesport chief nursing officer, said a large gathering is being planned at the Palisades event center in McKeesport, which will include efforts to reduce the stigma of mental illness. The team plans to bring together behavioral health, mental health and addiction treatment experts.
Dr. Evans said the breast cancer model will be evaluated until the end of 2020 to see if a guide to best practices can be developed and shared with others in the community.
He pointed out that a great need exists for more African American breast cancer surgeons and specialists, with the pool of African American medical students shrinking since 1968.
The journal JAMA Network Open recently reported results of a survey of 78,543 patients that found nonwhite, low-income and uninsured patients were less likely to report being treated with respect. They were more likely to consider it important that the professionals understand or share their culture.
‘A beautiful thing’
Although Ms. Scott has retired several times, she continues to work as a school crossing guard.
“I like to keep busy and make a little bit of money,” she said.
The outreach from Magee’s Ms. Fuller and her surgeon was above and beyond what she had experienced in other hospitalizations.
“The love that was shown to me was so different. It was a beautiful thing. I wasn’t scared, except at first,” she said. “Once they get ahold of you, they don’t stop.”