A Partnership to Reduce Breast Cancer Disparities in Allegheny County

Submission Date: January 2020

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Pennsylvania

States/Territories Involved: Pennsylvania

Funding Source: NACDD

Other Funding:

NACDD funding

Domain Addressed:

Community-Clinical Linkages

Public Health Issue:

Through participation in the 2018 ASTHO/CDC Breast Cancer Learning Community project, Pennsylvania analyzed disparities across geography and race identified populations with the highest disparities.

African American women have a higher mortality and late stage incidence age adjusted rate, but the same does not hold true when all invasive breast cancer is analyzed.  With the help of the Bureau of Health Informatics, the Breast Cancer Index was developed. The index was calculated using: late stage incidence, mortality and 5-year net cancer survival. Different weights were assigned to each measure, with breast cancer mortality rate having the greatest weight.  The Breast Cancer Index for Black women was particularly high in Allegheny and Philadelphia counties, which have the highest Black population in Pennsylvania. Many high-quality services are found in both the Pittsburgh and Philadelphia region; however, it is unclear whether those most in need of those services can access them.

Project Objectives:

The PA Department of Health and the Allegheny County Breast Cooperative aimed to reduce breast cancer disparities Allegheny County by increasing community demand for screenings, removing barriers to services, and establishing community support.  The goals for the first 6 months of the program were to:

• screen 100 women
• hold 12 community events and establish location to sustain monthly programming
• reach 250-300 women
• identify 2-5 churches to provide ongoing patient information around breast cancer
• erect 2 billboards in each community
• establish one breast cancer community expert who will serve as a community liaison

Program Action:

The Pennsylvania Division of Cancer Prevention and Control used additional funding from the National Association of Chronic Disease Directors to a reduce breast cancer disparities by partnering with the Allegheny County Breast Collaborative to increase capacity and target high need communities in Allegheny County.

The Allegheny County Breast Collaborative (ACBC) is a group of more than 20 representatives from community, health care and academic organizations dedicated to building a network of community support, engagement and advocacy for underserved women. The goal of the project is to reach individuals in a high disparity community, facilitate access to clinical services and ensure screening completion. The following steps were taken to address breast cancer disparities in Allegheny County

1. Health outcome data and GIS mapping identified four high need communities: Braddock, the Hill District, McKeesport and Penn Hills. This project focused on activities in Braddock and McKeesport.

2. Identify barriers and facilitators to breast cancer screening by concept mapping.

Barriers:

• limited screening hours
• transportation and child care
• lack of trust in the medical community
• fear of breast cancer diagnosis and treatment

Facilitators:

• strong community leaders
• local high-quality health care services
• support from the PA Breast and Cervical Cancer Early Detection Program and Susan G. Komen Foundation for screening

3. Partner with trusted community organizations and local health care services to:

• increase community demand for cancer screening through media and education
• reduce structural barriers through patient navigation and setting up alternative screening sites
• establish sustainable medical care by linking individuals to a medical home

Data/Other Information Collected:

In evaluating the project, we looked at the number of women screened through the PA Breast and Cervical Cancer Early Detection Program, the number of community events held, the number of health care providers participating in the project and serving as experts and identifying trusted community organizations that will support and promote breast health educational activities.

Impact/Accomplishments:

After six months;

• 126 women were evaluated for screening; 26 enrolled in the PA Brest & Cervical Early Detection Program
• 12 events were held; established relationship with Healthy Living Center in McKeesport.
• 375 women were reached through community events
• 1 church and 1 community center were identified
• 2 billboards were erected
• 1 one Breast Cancer Surgeon was identified as a breast cancer community expert

Particularly successful was “Gateway to Wellness” meeting, which was held on a Saturday. A breast screening event for women 35-50 years of age was embedded in the conference agenda. As a result of this event, 17 women were identified in need of screening, 12 qualified for the Breast and Cervical Cancer Screening Early Detection Program and 3 received Komen vouchers and 4 needed further evaluation.  Clients were directly navigated to a mammography center at University of Pittsburgh Hillman Cancer Center; Hillman offered Saturday screening hours to increase access to services.

Challenges/Lessons Learned:

There was a 17 percent increase in screening through the PA Breast and Cervical Early Detection Program since the start of this project. Women are being screened and “spreading the word” about breast health in McKeesport and Braddock. The project is slowly gaining the support and trust of the Community by partnering with local organizations. The Cooperative learned that it was more difficult than they expected to identify and reach the women in need.  Improving tracking, stronger outcome measures and more robust project evaluation are proposed to strengthen this program.

Activities supporting sustainability of the project include:

1. pursuing outside funding
2. hiring a retired nurse to support efforts
3. providing the necessary infrastructure to support the communities
4. develop relationships with the Housing Authority to increase our reach, not just for breast cancer
5. use minority focused marketing
6. connected to 9 FQHCs in the area
7. connected to a local Community Engagement Center in Homewood and will have a weekly presence

Next Steps:

This project was supported by the Cooperative Agreement Number 6NU38OT000286-01, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Program Areas:

Cancer, Health Equity and Cultural Competency

State Contact Information:

Pennsylvania
Joanna Stoms
Pennsylvania Department of Health
717-547-3213
jstoms@pa.gov

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