MODULAR MAMMOGRAPHY PROGRAM (MMP) Taking Mammography Screening to Rural Arkansas Kimberly S. Enoch, BS Project Coordinator UAMS/ACRC Modular Mammography Program Arkansas Cancer Community Network

LEARNING OBJECTIVES l Eliminate Disparities by Bridging Gaps l 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 INCIDENCE l 1 out of 7 women l 1,830 cases estimated for 2007 Early Detection = Key To Survival & Best Treatment Options ACS Cancer Facts & Figures 2007

BREAST CANCER MORTALITY l 410 cases in 2007 Early Detection = Key To Survival & Best Treatment Options ACS Cancer Facts & Figures 2007

MAMMOGRAPHY SCREENING l X-ray of Supposedly Healthy Breasts l Women Age 40 and Older l Two Views (Breast Compressions) of Each Breast < 1/3 of Arkansas Women

ANNUAL MAMMOGRAMS RECOMMENDED 40 & OLDER American Cancer Society Guidelines American Medical Association American College of Radiology American College of Ob& Gyn Earlier Stage 5 Year Survival Rate is 97% Average Cost of Breast Cancer:  Early Stage $12,000  Late Stage $143,000

FDA-APPROVED MAMMOGRAPHY FACILITIES Recent trend: National decline by 6.0% { }  # ♀ needing screening GAO Report: Mammography – Current Nationwide Capacity: July 2006

ARKANSAS STATISTICS CDC’s National Center for Chronic Disease Prevention & Health Promotion, 2003

ACCESS BARRIERS l Lack of FDA-approved mammography facilities l Lack of insurance l Lack of knowledge of navigating the system

UNDERSERVED COUNTIES Benton Washington Boone Carroll Sebastian Yell Crawford Searcy Marion Newton Madison Scott Logan Pope Johnson Franklin Baxter Van Buren Conway Poinsett Jefferson Cleveland Little River Independence Sharp Fulton Stone White Grant Hot Springs Pike Sevier Jackson Lawrence Randolph Izard Cleomes Faulkner Dallas Clark Howard Perry GarlandMontgomery Polk Clay Greene Cross Lonoke Prairie Miller Columbia Union Ashley Chicot Drew Bradley Desha Calhoun Ouachita Lafayette Lincoln Saline Crittenden Mississippi Craighead Monroe Saint Francis Lee Phillips Woodruff Pulaski Arkansas Nevada Hempstead 23 Focused Counties  No Mammograms  No Mammograms/ Mobile Van Little Rock

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

MOBILE COVERAGE Counties remaining outside mobile coverage: CalhounClevelandDallas GrantLincolnLonoke MonroePerryPrairie

ARKANSAS AFFILIATE KOMEN PROVIDES FUNDING Mammography Screening for 23 Arkansas Counties that Lack Mammography Facilities.

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

SOPHIE 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 UNIT

EQUIPMENT & SUPPLIES

DARK TENT – BATCH PROCESSING

BATCH PROCESSING

ACRC MAMMOGRAPHY OUTREACH NETWORK

COMMUNITY-BASED PARTNERS Primary Care Clinics Community Health Centers Local Health Units Nursing and Rehabilitation Senior Centers The Witness Project TM

INSTITUTIONAL COLLABORATION 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

METHODS 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 COUNTIES Franklin = 27 PPs = 2 Marion = 0Newton = 145 PPs = 3 Scott = 30 PPs = 3 Searcy = 54 PPs = 2 Total = 256 patients screened 10 PPs PP = Participating Provider

SOUTHWEST REGION Calhoun = 83 PPs = 1 Dallas = 166 PPs = 3 Lafayette = 197 PPs = 2 Miller = 16 PPs = 1 Montgomery = 0Nevada = 0 Pike = 30 PP = 2 Total = 492 patients screened 9 PPs

CENTRAL REGION Grant = 76 PPs = 5 Lonoke = 204 PPs = 2 Perry = 36 PP = 1 TOTAL: 316 women screened 8 PPs

NORTHEAST REGION Fulton = 45 PP = 1 Poinsett = 150 PP = 1 Woodruff = 135 PPs = 2 TOTAL: 330 women screened 4 PPs

SOUTHEAST 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

MEAN AGE: 57 Years ~ 14 ♀ / visit

RACE African American 33% Caucasian 65% Hispanic <2% Other <1%

INSURANCE DISTRIBUTION

SCREENING HISTORY 2,379 Women Screened 1,850 (78%) Annual 529 (22%) Baseline

Average distance ♀ would need to travel (one-way) to obtain a mammogram: 45.5 miles

OUTCOMES (03/2003 – 02/2007) l 2,379 Women Screened l 176 Visits to 24 Counties l 798 (34%) Abnormal Mammograms (additional views, etc.) l 68 Biopsies Recommended l 4 Cases of Cancer Found

NON-FOCUSED COUNTIES l 504 (21%) Women Screened in Conjunction with Local Community Organizations n Community Cancer Councils n Annual Awareness Expos Counties that have FDA-Approved Facilities

MODULAR MAMMOGRAPY PROGRAM 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

CONCLUSION 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: Sheinfeld GS. Am J Prev Med 2000;19:53-8.

PROS l Ability to Provide Needed Service to Women in Rural Settings l Job Satisfaction from the Responses of Women that Appreciate the Service l Not an Ordinary Clinical Setting l Ability to see beautiful scenery across Arkansas

CONS l Long Work Days l On the road for Many Hours l Cannot See Processed Films l Very physical – moving heavy equipment each visit (Sophie Unit, tool box, and other supplies).

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

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 Professor PI, Modular Mammography Program Medical Director, Women’s Oncology Clinic Director, Cancer Control Department of Surgery, Breast Surgical Oncology UAMS/ACRC

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