Removing Barriers to Care
Award recipients in CDC’s National Breast and Cervical Cancer Early Detection Program have found many innovative ways to help those in need of cancer screening get the tests they need. Below, we share highlights from some programs that helped women enroll in programs that covered the cost of their care, provided rides to doctor’s appointments, or offered cancer screening at a central location.
Navigators Help Patients Get Screened for Cancer in Pennsylvania
Pennsylvania’s Breast and Cervical Cancer Early Detection Program trained and paid for two patient navigators to help patients over a 4-month period. The navigators worked with two local health organizations to reach out to Latino and African populations. These two groups make up 40% of Philadelphia’s immigrant and refugee community.
Many of the program’s patients spoke little English. This made it hard for them to understand written materials, make appointments, or understand the medical care offered. They also didn’t know that they could get screened for cancer. Navigators worked to overcome these problems by—
- Giving patients information that takes their native culture and language into account.
- Helping patients overcome barriers to screening and following up with them if they had abnormal test results.
- Connecting patients to other services in the community.
- Giving patients one-on-one help.
During the 4 months the navigators worked, 138 patients used their services. Among them, 88 were screened and 40 made appointments on later dates. This project was successful, in part, because the navigators were from the communities and organizations they served. They built relationships with patients and program staff. As a result, patients said they planned to continue visiting the program for medical care, and they would spread the word about its services.
Free Clinic in Ohio Links Women to Breast and Cervical Cancer Screening
Free clinics in Ohio serve many women who are underserved, uninsured, and have low incomes who rarely get screened for breast or cervical cancer. Many of these free clinics don’t collect information about patients’ cancer screening history or have a process to refer eligible women to free cancer screening in the community.
The Ohio Breast and Cervical Cancer Project, Ohio State University, and the Ohio Association of Free Clinics started a project with Helping Hands, one of the free clinics. A study was done to find ways to link patients to screening services, which resulted in the use of a referral form to be filled out for all female patients who were 21 years old or older who came into the clinic for any service. A patient navigator contacted each patient to educate her about cancer screening and enroll her in appropriate services. Ohio State University sent the completed screening information back to the clinic.
Within the first five months of the project (February through June 2019), 50 women were referred to the Ohio Breast and Cervical Cancer Project for cancer screening. Of these women, 30 have been screened: 14 received Pap tests, 12 received HPV tests, and 25 received mammograms. Now, Helping Hands collects cancer screening information about its patients and evaluates all women for breast and cervical cancer screening.
Every Woman Counts at the Padres’ Ball Park
“We had so many women come who were scared, nervous, and anxious, but left feeling like they were cared for, heard, and less uncertain than when they arrived. Some women had gone several years since their last exam; several had lumps that they hadn’t gotten checked out; and others had a family history of breast cancer.” – Event organizer
A higher percentage of women die from breast cancer in San Diego County than in California overall. The number of women who qualify for low-cost screening services in San Diego County nearly doubled from 2016 to 2017. But one-third of women over the age of 40 have never had a mammogram because they have trouble taking time off from work or arranging for child care, or because they don’t know about breast cancer. More than half of these women earn less than $40,000 per year.
In partnership with Susan G. Komen San Diego and the San Diego Padres Major League Baseball team, the California Every Woman Counts program hosted a family-friendly community event, Park at the Park, at the Padres’ baseball park in May 2019. The park is in a central location that is easy for people to get to on public transportation. This event, which is now held every year, made it convenient for women in the community to get health education, clinical breast exams, and mammograms. Sixty-six women got mammograms in mobile mammography units at the first event. Twenty-six were pre-registered and 40 were registered and linked to services on-site for continued follow-up. Of the participating women, 17 had symptoms and were given diagnostic mammograms on site, and 11 women were given referrals for more tests. All 66 women had no health insurance, or their health insurance wouldn’t pay for the tests.
Dedicated Team Connects Patients in Alaska to Health Care Coverage
Patients at the SouthEast Alaska Regional Health Consortium qualify for a variety of health care programs. But many were not signing up for these programs because of confusing choices and long applications. As a result, they were not receiving health care.
The consortium formed a Patient Health Benefits team to help patients figure out which health care programs they qualify for and to help them enroll. In the fall 2018, the consortium’s women’s health program worked with the team to add breast and cervical cancer screening services to their eligibility screening process. The team sends e-mail messages about eligible women to staff in the consortium so they can contact the women and schedule them for cancer screenings. The new process has expanded the SouthEast Alaska Regional Health Consortium’s reach.
Free Rides Help Women in Memphis Get Mammograms
People living in Memphis have higher rates of getting and dying from cancer than people in other parts of Tennessee. Some women in the Memphis area have trouble getting a ride to go to the doctor. This makes it hard for them to get screened for breast cancer.
The Tennessee Breast and Cervical Screening Program began planning a project to take place in late 2018 to early 2019 to offer women with low incomes free rides to get their mammograms and to get follow-up care, if needed. To make sure the project served women in need, program staff looked at breast cancer rates in different ZIP Codes, the locations where mammograms are provided, and mobile mammogram van routes. The patients who got free rides provided their age and ZIP Code to program staff.
The project lasted three months. During this time, 46 women were given 261 rides to and from their medical appointments. All of these women lived in ZIP Codes with high rates of breast cancer. Sharing these numbers and ZIP Codes with local cancer coalitions resulted in a large hospital in Memphis starting discussions to become a cancer screening service partner for the Tennessee Breast and Cervical Screening Program.
Rhode Island Program Helps Women Who Can’t Afford Screening
“It means so much to me that this program is helping me get the health care I need to stay proactive against breast cancer.”
Medicaid is helping women in Rhode Island who have low incomes get screened for breast and cervical cancer. But some women—even those who have health insurance—still can’t afford to get recommended screening tests and follow-up care.
The Rhode Island Women’s Cancer Screening Program asked cancer screening facilities throughout the state to offer follow-up procedures to women who had abnormal screening test results. This allowed the screening facilities to refer eligible women to follow-up procedures at no charge.
Between 2015 and 2018, the cancer screening program helped 127 insured women with low incomes pay for follow-up services. As a result, one non-invasive and 13 invasive breast cancers were diagnosed and one cervical cancer was diagnosed. With the help of community partners, the program now helps women who earn as much as four times the federal poverty level. So far, 42 more women have received program assistance.