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VOL. 132 | NO. 212 | Wednesday, October 25, 2017

Consortium Seeks Breast Cancer Policy Reforms

By Michael Waddell

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Two-time breast cancer survivor Dr. Debra Bartelli and members of the Memphis Breast Cancer Consortium are pushing to increase awareness of breast cancer in Memphis because they know first-hand that early detection and treatment will lead to higher survival rates.

“There’s a lot of fear. No one likes to hear that they have cancer or that they even have found a lump,” said Bartelli, a member of the MBCC steering committee. “A lot of times women will ignore that and think it will go away because they don’t want to hear the cancer diagnosis. But the earlier it is diagnosed and you get into treatment, the better the possible outcome.”

October is Breast Cancer Awareness Month, and on Tuesday, Oct. 24, the Common Table Health Alliance and MBCC hosted the first local policy forum to discuss breast cancer disparities among African-Americans and how policies impact early detection and survival.

Approximately one in eight women in the U.S. are affected by breast cancer, and Memphis has one of the highest mortality-rate disparities among African-American women, who die at nearly two times the rate of Caucasian women – despite the fact that they are diagnosed with breast cancer at roughly the same overall rate.

In fact, Memphis ranked the worst out of 40 large cities in terms of mortality rate for African-American women with breast cancer, according to a 2014 national Avon Breast Cancer Crusade study. Since then, that rate has improved, moving Memphis from worst to seventh-worst among the same cities.

Carla Baker

“We’ve been working for more than a year trying to reduce disparities in Memphis and trying to increase the awareness around the need for mammograms and how early detection of breast cancer saves lives,” said Carla Baker, project director for the MBCC, a 31-person organization with members from nonprofits, hospitals, survivor groups, and the American Cancer Society. “We have a long way to go, but we think that’s a significant improvement.”

With early detection and treatment, the relative five-year survival rate for women is currently 100 percent.

Human resource and legislative policies have a direct impact on breast cancer survival rates.

“The Affordable Care Act helped some people by reducing, and in many cases eliminating, co-pays that women have to pay for mammograms,” Baker said. “One thing we’re looking at is to put something in place so that people will have the paid time off to be able to go and get health screenings. If you’re living from paycheck to paycheck, you can’t afford to take a day off to go get the test done even though it will be paid for by insurance.”

The MBCC’s policy group looked at various insurance policies and laws that affect health care, and they identified some of the barriers or problems people were having navigating the health care system to get a mammogram or get treatment after diagnosis.

After examining the work being done in other states, recommendations are being made to local politicians, insurance providers, employers and social services organizations.

A call to action was made at Tuesday’s forum.

“In general, Tennessee is very similar to surrounding states in terms of the policies we have for improving access to coverage for mammograms,” said Dr. M. Paige Powell, assistant professor in health systems management policy at the University of Memphis School of Public Health.

She said there are other states doing some innovative things, and the hope is that Tennessee will become more like those states “with some of the policies” that helping reducing mortality rates.

Powell sees access to screenings and coverage as big factors in the disparities being seen in Memphis and Tennessee, and points to the fact that Tennessee did not expand Medicaid as part of the Affordable Care Act.

“At the same time, Memphis has several systems working with Avon, Coleman and other foundations to provide programs for people who are uninsured to receive mammography services if they don’t have coverage for it,” Powell noted.

Along with lack of access and insurance coverage, Powell sees some cultural barriers in the African-American community like a degree of what she calls fatalism.

MBCC has developed a plan to combat this that includes education/awareness, mammogram capacity, treatment capacity, the care process, policy and quality of care.

In Memphis, the areas where the highest incidences and mortality rates of breast cancer exist are in ZIP codes such as 38109 and 38106, which have few (38106) or no (38109) mammogram facilities. Mobile mammogram units from Baptist and Methodist hospitals are helping the problem in those and other parts of the city.

“I try to encourage women all the time to know their bodies and to do self-exams,” said Bartelli, who is also a University of Memphis research associate professor in the School of Public Health. “If they feel something strange, go to the doctor and have it checked out.”

In the 11 years between her two incidents of breast cancer (1999 and 2010), Bartelli saw huge advances in cancer diagnosis and treatment.

“The medications are so much better now. You are able to be on chemo and be functional in many cases,” she said. “There are support groups in the community and a lot of resources available.”

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