KAREN CODJOE, MD, MPH, CLC HEALTH OFFICER FAYETTE COUNTY West Tennessee Cancer Mortality Disparity

1. DISCUSS CANCER REGISTRY QUANTITATIVE DATA 2. DISCUSS QUALITATIVE DATA RELATED TO BREAST CANCER MORTALITY 3. DISCUSS PROPOSAL TO ADDRESS BREAST CANCER MORTALITY DISPARITY IN RURAL WEST TENNESSEE objectives

Tennessee Cancer Deaths Disparity

Identify mortality to incidence ratio as sensitive indicator to detect breast cancer disparity 7 Breast cancer mortality to incidence ratio in TN exceeds US ratio, 4 rural West counties greatly exceeds TN ratio. Tennessee Department of Health

CountyPopulationUninsuredCounty Percent Black % Fayette %28% Haywood Lauderdale Tipton Shelby %52.3 BRFSS data: Percentage of women over 40 reporting NOT having a mammogram in past two years: 2005 Shelby 15.4% Southwest 38.7% 2006 Shelby 22.6% Southwest 29.3% 2007 Shelby 23.3% Southwest 22.6% 2008 Shelby 14.8% Southwest 30.0% 2009 Shelby 18.4% Southwest 27.4% 2010 Shelby 16.8% Southwest 39.7%

Community Based Collaborative Effort Addressing Breast Cancer Disparities in Four Rural Counties

TO UNDERSTAND AND ASSESS WHY BREAST CANCER MORTALITY RATES ARE HIGHER AMONG AFRICAN AMERICAN WOMEN IN FOUR RURAL COUNTIES IN WEST TENNESSEE Project Aim

Plan and Approach Developed focus group questions Developed focus group work plan and methodology Identified key stakeholders Recruited focus group participants Implemented focus group sessions Data analysis Disseminate focus group findings

Focus Group Questions African American Women  Why is breast cancer mortality high in rural west tn counties among African American women?  Do you know the reasons why some women don’t go for screening? Community Lay Health Workers  What factors lead to poor health outcomes? Faith Based Organization Leaders  Does faith/religion have anything to do with how women perceive breast cancer or use services? Medical Providers  Why are there geographic gaps in the availability of health care providers?

African American Women Breast Cancer mortality is high among African American Women  Lack of knowledge, delay in screening leads to late diagnosis Reasons why some women don’t go for screening  Transportation barriers, negative medical results Messages women have been told about breast cancer  Mammograms hurt, mammograms not necessary for women with small breasts Recommendations on how to address the problem  Increase knowledge of area services, patient navigators

Community Lay Health Workers Breast Cancer mortality is high among African American women  Secrecy of family health history, Factors that lead to poor outcomes  lack of insurance at the time of diagnosis, lack of sustainability of local programs Recommendations on how to address the problem  Promote health care information, encourage f/u continuation of care Statements that African American women believe, understand and act on regarding cancer  Fear, aggressive/ proactive in your own health

Faith Based Organization Leaders How does breast cancer affect African American women in your church:  Supportive network, mistrust of health departments Does faith have anything to do with how women perceive breast cancer or use services  literal thinking, testimonials Role faith leaders and communities play in overall health and wellness, illness, death  Health ministries, provide congregations with easy access to health information How can we work best with you on the issue that affects your community  church-church partnerships, church-health dept partnerships

Medical Providers Breast cancer mortality is high among African American women  Stage of diagnosis, missed health appointments Factors that lead to poor outcomes  Lack of trust in the health care system, lack of knowledge regarding one’s health status Describe the availability of health care services  PCP vs health department Causes of lack of access to breast cancer services  Lack of funding, poverty

POLICY Tennessee Breast and Cervical Cancer Screening Program has county specific guidelines for the distribution and utilization of funding in Fayette, Haywood, Lauderdale, and Tipton Proposal

Women over 50 who have never had a mammogram Target population

Community Partners AHEC (Area Health Education Center) McKnight clinic Stanton Community Health Center Lauderdale County Primary Care Clinic Tipton County Primary Care Clinic Baptist Memorial Hospital System Research Center on Health Disparities, Equity and the Exposome at UTHSC

Area Health Education Center Area Health Education Center (AHEC) received funding from Susan G. Komen Foundation to address breast cancer screening and treatment in Fayette county Program components: trained lay health workers, churches, mobile mammography unit (Baptist Hospital)

CountyPopulationUninsuredCounty Percent Black % Fayette %28% Haywood Lauderdale Tipton Shelby %52.3 BRFSS data: Percentage of women over 40 reporting NOT having a mammogram in past two years: 2005 Shelby 15.4% Southwest 38.7% 2006 Shelby 22.6% Southwest 29.3% 2007 Shelby 23.3% Southwest 22.6% 2008 Shelby 14.8% Southwest 30.0% 2009 Shelby 18.4% Southwest 27.4% 2010 Shelby 16.8% Southwest 39.7%

McKnight Clinic Primary care clinic located in Somerville, Tn (Fayette County) Source of referrals for breast cancer screening

Stanton Community Health Center Federally qualified health clinic located in Haywood County Source of referral for breast cancer screening

Lauderdale/Tipton County Primary Care Clinic Located in county health department Source of referral for breast cancer screening

Baptist Memorial Hospital Susan G. Komen grant recipient for mammography services Application required for means testing

Baptist Women’s Health Center Grant Application Process To be eligible for available grants at Baptist Women’s Health Center, a patient must: Be uninsured Reside in Shelby, Tipton, or Fayette for the Komen Grant Reside in Shelby, Tipton, Fayette, DeSoto, or Tunica County for the Pink Ribbon Grant Meet financial criteria based on the current federal poverty guidelines Have a Physician Instructions for applying: Fill out the Grant application and submit with the application: Proof of residency. (MLGW bill, etc.) Please list all family members (including yourself). Family members are person related by birth, marriage, or adoption living together in the home along with the patient. Also included are children who are full time students in an accredited college. Proof of Income of all people living in household – Example: 3 check stubs, W2 form, income tax return for previous year or any state assistance documents Driver’s license or Picture id. Please mail or fax completed applications to Lyn Sperling at (901) Grant results will take 1 week to process. Grants are provided to the Baptist Memorial Hospital Foundation through Susan G. Komen for the Cure, Breast Cancer Eradication Initiative, and Breast Cancer Relief Foundation.

Research Center on Health Disparities, Equity and the Exposome at UTHSC Funding for community outreach 500 survivors will UTCHS for a rally. They will then go out into their community and encourage early screening and detection Motto: ‘not my daughter and not on my watch”

Mortality Prevention Program Modeled after Tennessee Department of Health PPI( Primary Prevention Initiative) teams formed in Fayette, Haywood, Lauderdale and Tipton counties Team composition:  County health department staff  Regional office staff  Community partners Project focused on reaching out to women over 50 in those counties through the churches and community events.

Mortality Prevention Program Maintain contact with county specific partner organization for the referrals Assist with logistics of obtaining mammogram Assist with follow-up using the framework of TBCCS program

Challenges Hard to reach population Personal Belief systems Funding for mammography Logistics for obtaining mammography