ADVICE FOR PROFESsIONALS

Cancer Care developed its first Breast Health Awareness Program in 1985. Since that time, we have taught thousands of women the importance of early detection through mammography screening, regular clinical examination by a physician and breast self examination.

We think you will find this Professional Brief useful in developing a Breast Health Awareness and Mammography Program in your own setting. The "Nuts and Bolts" section is specifically designed to help you launch such a program.

RATIONALE

Breast cancer is a disease that affects thousands of American women each year. Breast cancer cannot be prevented, but early detection increases the likelihood of less invasive surgery and treatment, less suffering and a more positive outcome. Yet many women are still diagnosed with breast cancer in advanced stages due to lack of timely screening.

All women are at risk for breast cancer, however, the majority of cases are diagnosed in women over age fifty. A Breast Health Awareness and Mammography Program can be specifically targeted to older women, women isolated from mainstream medical and social services and to other underserved groups. Successful programs can change the health practices of women, improve survival rates for those diagnosed with breast cancer and enhance their quality of life.

NUTS AND BOLTS

1. Make a commitment to programming about breast health awareness and mammography. This may require educating your own staff first. To do this, call a local cancer organization or hospital to arrange for a speaker, or, if this is not possible, there are a number of instructional videotapes available.

2. Identify specific groups you want to reach. For example, is your priority population older women, underserved women, women in a specific entity such as a retirement complex, or women of a certain ethnic group?

3. Evaluate your own resources to reach your identified group. It is usually advisable to approach similar or like-minded organizations in your community to work with you. This enhances your credibility, helps with funding, and allows more people to participate in planning and implementing the program.

4. Set up meetings in the community with leaders and representatives of the women you want to reach. For example, contact leaders in churches, synagogues, senior centers, the local AARP chapter, retirement housing, the state health department, civic and social clubs, Meals on Wheels. It is very important to gain the trust of the group you want to reach. Representatives of these groups may wish to join with you in cosponsoring a program and may help you reach your targeted population. Consideration of age, ethnicity, and language are crucial in undertaking outreach to any specific group. Sensitivity to these factors is vital before presenting breast health programs to community leaders.

5. After meeting with community leaders and incorporating their input, decide on program goals. Do you want to: 1) increase awareness; 2) teach skills such as breast self-examination and promote healthy behaviors; and/or 3) provide mammography screening? Every organization, even with limited resources, can take steps to increase awareness through distribution of brochures or participation in health fairs. With more resources, it is possible organize screening programs.

6. If you want to provide screening, you must identify an FDA- accredited provider. The American College of Radiology can help with this as well as your local hospitals and mammography centers. You must decide if you will offer free or reduced cost mammography, medicaid and insurance benefits. Then base your negotiation with the provider on how much funding you will need to pay for screening. You will also need an estimate of how many women of what age you plan to reach.

7. Design your program with a budget, staffing needs, a publicity plan, and evaluation. Consider what day you will reach the highest number of people in your target audience; for example, Sunday is the best day if you are going to a church.

8. Obtain funding. Foundations, corporations, and individuals are all sources of funding. You will need a written proposal and a budget. Obtaining funding can take awhile. If you have experts in your community working with you, it will help with funding. If you want to provide child care, transportation, or 'gifts' to encourage participation, try to obtain these free of charge.

9. Obtain free materials. The National Cancer Institute, the Board of Sponsors of National Breast Cancer Awareness Month, and other organizations which deal with breast cancer have a large variety of free materials for distribution. Such materials can be used to reinforce learning from the program.

10. Publicize your program through flyers or local advertising. If you are providing child care, transportation, or a gift item for participation, include this in your publicity.

11. Do the program. Develop a timetable, have a preparatory meeting for program staff so that each person knows his/her responsibility. Recruit volunteers to help. Screening programs are labor intensive, and you need staff and/or volunteers to help women fill out forms, walk through the actual procedure and answer questions about follow up. Make sure that there are people available who speak the language of participants. Ideally, some of the organizers of the program will come out of the group for whom you are providing mammography.

12. Follow up on results. One person on your team should be responsible for making sure that there is follow up to the screening, both in terms of women receiving notification of their results and any diagnostic work that may be necessary afterward. As part of the initial program design, you should consider where women will be referred if they need medical follow up.

13. Evaluate. Do an evaluation with participants and community leaders. This can be done at the time of the program, or later, by telephone if most participants have phones. Evaluate your results: did you reach the number of women you wanted to, did you reach the population you targeted? In the case of positive findings, did women follow the screening guidelines? Evaluation data is crucial for future planning.

14. Take what you learned, and target another group in your community. Enlist women who have participated in the program to be "ambassadors" to others in their community and utilize their help in setting up future programs.