MODULAR MAMMOGRAPHY MODULAR MAMMOGRAPHY PROGRAM (MMP)PROGRAM (MMP)

Taking Mammography Screening to Rural Arkansas

Kimberly S. Enoch, BSProject Coordinator UAMS/ACRC Modular Mammography ProgramArkansas Cancer Community Network

LEARNING OBJECTIVESLEARNING OBJECTIVES

Eliminate Disparities by Bridging Gaps Utilize a MMP for Screening Services in Rural

and Underserved Arkansas Initiate Successful Partnerships between an

Academic Institution and Local/State Community Organizations to Implement Effective and Sustainable Models

BREAST CANCER INCIDENCEBREAST CANCER INCIDENCE

1 out of 7 women 1,830 cases estimated for 2007

Early Detection = Key To Survival & Best Treatment Options

ACS Cancer Facts & Figures 2007

BREAST CANCER MORTALITYBREAST CANCER MORTALITY

410 cases in 2007

Early Detection = Key To Survival & Best Treatment Options

ACS Cancer Facts & Figures 2007

MAMMOGRAPHY SCREENINGMAMMOGRAPHY SCREENING

X-ray of Supposedly Healthy Breasts Women Age 40 and Older Two Views (Breast Compressions) of

Each Breast

< 1/3 of Arkansas Women

ANNUAL MAMMOGRAMS ANNUAL MAMMOGRAMS RECOMMENDED 40 & OLDERRECOMMENDED 40 & OLDER

American Cancer Society GuidelinesAmerican Medical AssociationAmerican College of RadiologyAmerican College of Ob& Gyn

• Earlier Stage• 5 Year Survival Rate is 97%• Average Cost of Breast Cancer:

Early Stage $12,000Late Stage $143,000

FDA-APPROVED FDA-APPROVED MAMMOGRAPHY FACILITIESMAMMOGRAPHY FACILITIES

•Recent trend:

• National decline by 6.0% {2001-04}

• # ♀ needing screening

GAO Report: Mammography – Current Nationwide Capacity: July 2006

ARKANSAS STATISTICSARKANSAS STATISTICS

CDC’s National Center for Chronic Disease Prevention &

Health Promotion, 2003

ACCESS BARRIERSACCESS BARRIERS

Lack of FDA-approved mammography facilities

Lack of insurance Lack of knowledge of navigating the

system

UNDERSERVED COUNTIESUNDERSERVED COUNTIESBenton

Washington

BooneCarroll

Sebastian

Yell

Crawford

Searcy

Marion

NewtonMadison

Scott

Logan

Pope

JohnsonFranklin

Baxter

Van Buren

Conway

Poinsett

Jefferson

Cleveland

Little River

Independence

Sharp

Fulton

Stone

White

GrantHot SpringsPike

Sevier

Jackson

Lawrence

Randolph

Izard

Cleomes

Faulkner

DallasClark

Howard

Perry

GarlandMontgomeryPolk

Clay

Greene

Cross

Lonoke

Prairie

Miller

Columbia UnionAshley

Chicot

Drew

Bradley

Desha

CalhounOuachita

Lafayette

Lincoln

Saline

Crittenden

MississippiCraighead

Monroe

Saint Francis

Lee

Phillips

Woodruff

Pulaski

Arkansas

NevadaHempstead

23 Focused 23 Focused CountiesCounties

No MammogramsNo Mammograms

No Mammograms/ No Mammograms/ Mobile VanMobile Van

Little Little RockRock

MOBILE COVERAGEMOBILE COVERAGE

• NARMC – Harrison• SEMMC – Ft. Smith• SBRHS – Jonesboro• SJRHC – Hot Springs

MOBILE COVERAGEMOBILE COVERAGE

Counties remaining outside mobile coverage:

Calhoun Cleveland Dallas

Grant Lincoln Lonoke

Monroe Perry Prairie

ARKANSAS AFFILIATE ARKANSAS AFFILIATE KOMEN PROVIDES KOMEN PROVIDES

FUNDINGFUNDING

Mammography Screening for 23 Arkansas Counties that Lack

Mammography Facilities.

GOALS OF MMPGOALS OF MMP

• Provide Onsite Breast Cancer Screening & Education in 23 Underserved Counties

• Provide Resources of Referrals for Abnormal Screenings

• Work With AR DHHS to Ensure No Woman Goes Unscreened

SOPHIE TRANSPORT VANSOPHIE TRANSPORT VAN

Shown is a transport van equipped with a hydraulic lift system.

SOPHIE TRANSPORT VANSOPHIE TRANSPORT VAN

The hydraulic lift allows the SOPHIE to be transported directly into a screening facility.

• Access to Wheelchair Ramp

• Minimal 36” Door Frame

SOPHIE UNITSOPHIE UNIT

EQUIPMENT & EQUIPMENT & SUPPLIESSUPPLIES

DARK TENT – DARK TENT – BATCH PROCESSINGBATCH PROCESSING

BATCH PROCESSINGBATCH PROCESSING

COMMUNITY-BASED PARTNERSCOMMUNITY-BASED PARTNERS

• Primary Care Clinics • Community Health Centers • Local Health Units• Nursing and Rehabilitation Senior Centers• The Witness Project TM

INSTITUTIONAL INSTITUTIONAL COLLABORATIONCOLLABORATION

• American Cancer Society• Arkansas Department of Health and

Human Services (AR DHHS)• Arkansas Cancer Coalition • NCI Cancer Information Service• NCI Centers to Reduce Cancer Health

Disparities

METHODSMETHODS

• PCP within the Intervention Counties • Screening Mammos Only• Resource Manual Distributed

• Screening Guidelines• Focused MMP Counties• Access & Space Requirements• Payment Mechanisms for Coverage• Referral Directory

NORTHWEST COUNTIESNORTHWEST COUNTIES

Franklin = 27

PPs = 2

Marion = 0 Newton = 145

PPs = 3

Scott = 30

PPs = 3

Searcy = 54

PPs = 2

Total = 256 patients screened

10 PPs

PP = Participating Provider

SOUTHWEST REGIONSOUTHWEST REGIONCalhoun = 83

PPs = 1

Dallas = 166

PPs = 3

Lafayette = 197

PPs = 2

Miller = 16

PPs = 1

Montgomery = 0 Nevada = 0

Pike = 30

PP = 2

Total = 492 patients screened

9 PPs

CENTRAL REGIONCENTRAL REGION

Grant = 76

PPs = 5

Lonoke = 204

PPs = 2

Perry = 36

PP = 1

TOTAL: 316 women screened

8 PPs

NORTHEAST REGIONNORTHEAST REGION

Fulton = 45

PP = 1

Poinsett = 150

PP = 1

Woodruff = 135

PPs = 2

TOTAL: 330 women screened

4 PPs

SOUTHEAST REGIONSOUTHEAST REGION

Cleveland = 54

PP = 1

Lee = 113

PPs = 3

Lincoln = 5

PP = 1

Monroe = 62

PP = 2

Prairie = 247

PP = 5

TOTAL: 481 women screened

12 PPs

SCREENING by REGION

481

330316

492

124

Northwest Southwest Central Northeast Southeast

MEAN AGE: 57 YearsMEAN AGE: 57 Years~ 14 ♀/ visit

RACE

AfricanAmerican

33%

Caucasian65%

Hispanic<2%

Other<1%

INSURANCE DISTRIBUTIONINSURANCE DISTRIBUTION

24%2%

37%

29%

7%

1%

Private SelfMedicare BreastcareMedicaid Grant

SCREENING HISTORYSCREENING HISTORY

2,379Women

Screened 1,850(78%)

Annual

529(22%)

Baseline

Average distance Average distance ♀ would♀ wouldneed to travel need to travel (one-way)(one-way)

to obtain a mammogram:to obtain a mammogram:45.5 miles45.5 miles

OUTCOMES (03/2003 – 02/2007)OUTCOMES (03/2003 – 02/2007)

2,379 Women Screened 176 Visits to 24 Counties 798 (34%) Abnormal Mammograms

(additional views, etc.) 68 Biopsies Recommended 4 Cases of Cancer Found

NON-FOCUSED COUNTIESNON-FOCUSED COUNTIES 504 (21%) Women Screened in Conjunction

with Local Community Organizations Community Cancer Councils Annual Awareness ExposCounties that have FDA-Approved Facilities

MODULAR MAMMOGRAPY MODULAR MAMMOGRAPY PROGRAMPROGRAM

• Eliminates the Physical Barrier of Access• Can be a Resource for the Primary Care

Setting• Serve as a Reminder to Physicians and

Patients for Annual Mammograms

CONCLUSIONCONCLUSION

Screening at PCP offices: • Main source of health education • Most cost effective strategy • Critical position to advise & order

Breen N. Am J Public Health 1994;84:62-7.Saywell RM. Am J Manag Care 2003;9:33-44.Sheinfeld GS. Am J Prev Med 2000;19:53-8.

PROSPROS Ability to Provide Needed Service to

Women in Rural Settings Job Satisfaction from the Responses of

Women that Appreciate the Service Not an Ordinary Clinical Setting Ability to see beautiful scenery

across Arkansas

CONSCONS Long Work Days On the road for Many Hours Cannot See Processed Films Very physical – moving heavy

equipment each visit (Sophie Unit, tool box, and other supplies).

MMP STAFFMMP STAFF

Ronda S. Henry-Tillman, M.D., FACS, PI Kimberly S. Enoch, BS, Project Coordinator Margaret E.G. Thompson, MD, Breast Fellow Keiva L. Bland, MD, Breast Fellow Kelly Troillett, RT Part-time Technologist Janice Newman, RT, Part-time Technologist

DOCTORS’ ORDERS:DOCTORS’ ORDERS: “Taking the modular mammography to primary care clinics reinforces the necessity for primary care physicians to become more proactive in breast cancer early detection screening.”

Ronda Henry-Tillman, M.D., Associate ProfessorPI, Modular Mammography ProgramMedical Director, Women’s Oncology ClinicDirector, Cancer ControlDepartment of Surgery, Breast Surgical OncologyUAMS/ACRC

ACKNOWLEDGEMENTSACKNOWLEDGEMENTS

Special Thanks to: American Cancer SocietyAmerican Cancer Society Arkansas Affiliate, Komen Foundation Arkansas Community Foundation UAMS/ACRC Cancer Control Outreach Center Ronda S. Henry-Tillman, MD, FACS The Witness Project™ MMP Team