Transcript No Slide Title

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

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
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 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 MORTALITY

410 cases in 2007
Early Detection = Key To Survival & Best
Treatment Options
ACS Cancer Facts & Figures 2007
MAMMOGRAPHY 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
RECOMMENDED 40 & OLDER
• Earlier Stage
• 5 Year Survival Rate is 97%
• Average Cost of Breast Cancer:
Early Stage $12,000
Late Stage $143,000
American Cancer Society Guidelines
American Medical Association
American College of Radiology
American College of Ob& Gyn
FDA-APPROVED
MAMMOGRAPHY FACILITIES
•Recent trend:
• National decline by 6.0% {2001-04}
•  # ♀ 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
Lack of FDA-approved mammography
facilities
 Lack of insurance
 Lack of knowledge of navigating the
system

UNDERSERVED COUNTIES
Carroll
Benton
Clay
Randolph
Fulton
Baxter
Boone
Marion
Greene
Izard
Madison
Washington
Sharp
Lawrence
Newton
Searcy
Crawford
Van Buren
Johnson
Franklin
Mississippi
Craighead
Stone
Independence
Cleomes
Poinsett
Jackson
Pope
Cross
Conway
Sebastian
Logan
Faulkner
Woodruff
Saint Francis
Yell
Perry
Scott
Little
Rock
Prairie
Lee
Lonoke
Monroe
Pulaski
Montgomery
Saline
Garland
Phillips
Polk
Arkansas
Grant
Hot Springs
Jefferson
Pike
Sevier
Crittenden
White
Howard
Clark
Dallas
Lincoln
Cleveland
Desha
 No Mammograms
Little River
Hempstead
Nevada
Ouachita
Drew
Calhoun
Bradley
Miller
Columbia
Lafayette
Union
Ashley
23 Focused Counties
Chicot
 No Mammograms/
Mobile Van
MOBILE COVERAGE
• NARMC – Harrison
• SEMMC – Ft. Smith
• SBRHS – Jonesboro
• SJRHC – Hot Springs
MOBILE COVERAGE
Counties remaining outside mobile coverage:
Calhoun
Cleveland
Dallas
Grant
Lincoln
Lonoke
Monroe
Perry
Prairie
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.
SOPHIE UNIT
• Access to Wheelchair
Ramp
• Minimal 36” Door
Frame
EQUIPMENT &
SUPPLIES
DARK TENT –
BATCH PROCESSING
BATCH PROCESSING
COMMUNITY-BASED PARTNERS
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Primary Care Clinics
Community Health Centers
Local Health Units
Nursing and Rehabilitation Senior Centers
The Witness Project TM
INSTITUTIONAL
COLLABORATION
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•
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 Marion = 0
PPs = 2
Newton = 145
PPs = 3
Scott = 30
PPs = 3
Total = 256 patients
screened
10 PPs
PP = Participating Provider
Searcy = 54
PPs = 2
SOUTHWEST REGION
Calhoun = 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 REGION
Grant = 76
PPs = 5
Lonoke = 204
PPs = 2
TOTAL: 316 women screened
8 PPs
Perry = 36
PP = 1
NORTHEAST REGION
Fulton = 45
PP = 1
Poinsett = 150 Woodruff = 135
PP = 1
PPs = 2
TOTAL: 330 women screened
4 PPs
SOUTHEAST REGION
Cleveland = 54 Lee = 113
PP = 1
PPs = 3
Lincoln = 5
PP = 1
Monroe = 62
PP = 2
TOTAL: 481
women screened
12 PPs
Prairie = 247
PP = 5
SCREENING by REGION
492
316
481
330
124
Northwest
Southwest
Central
Northeast
Southeast
MEAN AGE: 57 Years
~ 14 ♀/ visit
RACE
Caucasian
65%
African
American
33%
Hispanic
<2%
Other
<1%
INSURANCE DISTRIBUTION
29%
7%
1%
37%
2%
Private
Medicare
Medicaid
24%
Self
Breastcare
Grant
SCREENING HISTORY
529
(22%)
Baseline
2,379
Women
Screened
1,850
(78%)
Annual
Average distance ♀ would
need to travel (one-way)
to obtain a mammogram:
45.5 miles
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 COUNTIES

504 (21%) Women Screened in Conjunction
with Local Community Organizations
 Community Cancer Councils
 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;9:33-44.
Sheinfeld GS. Am J Prev Med 2000;19:53-8.
PROS
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

CONS
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).
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MMP STAFF
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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:
“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:
 American 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