New Mammography Van Unveiled in Newark, NJ
Photo by Doris Cortes, UMDNJ. Breast cancer survivors joined with the City of Newark, the Susan G. Komen for the Cure, and University of Medicine and Dentistry of New Jersey to unveil the “Mammography in Motion” vehicle, which will provide Newark residents with breast cancer screenings and information about breast cancer awareness. From left: Pamela Hodges, Ann Davis, and Roselyn Harkey, all Newark residents and breast cancer survivors.
The City of Newark, NJ, the University of Medicine and Dentistry of New Jersey (UMDNJ), and the Susan G. Komen for the Cure North Jersey recently unveiled a new and expanded Mobile Mammography Van, aptly called “Mammography in Motion.” According to UMDNJ, “The Mammography in Motion mobile van provides access to screening mammograms, clinical breast exams and educational information for uninsured and underinsured residents in Newark and other northern New Jersey communities.”
As I reported earlier, studies have indicated that uninsured women are diagnosed with larger tumors and at later stages than otherwise similar, but insured women. The cause of this later and larger diagnosis may be attributable, in part, to a lack of mammography providers — an indication of just how critical the van is to the Newark community.
The new van was funded through the North Jersey Affiliate of Susan G. Komen for the Cure and is markedly more advanced and comfortable than its predecessor, which was a retro-fitted recreational vehicle that provide analog, as opposed to digital, mammography. The van is a part of the New Jersey CEED (Cancer Education and Early Detection) S.A.V.E. (Screening Access of Value to Essex) Women and Men Project. According to Catherine Marcial, Project Coordinator for S.A.V.E. Women, the new van is bigger and more pleasant. It now has an exam room, changing room, reception area and all updated equipment. She also pointed out that providers on the van — a physician or physician assistant and a mammography technician from UMDNJ — offer pelvic exams, PAP Smears (cervical cancer screenings) and recommend colorectal cancer screenings when warranted. Deborah Q. Belfatto, Komen North Jersey Affiliate co-founder and executive director, commented that, “The Mammography in Motion program will provide state-of-the-art breast health screening services for women right in their own neighborhoods. This is a giant step in addressing access to care for all women, especially those with no readily available resources.” This is especially true given the prediction that the demand for mammography, and other outpatient diagnostic imaging, is expected to increase by double digits over the next three years. Further, there is strong evidence that the provision of cancer education and screening programs serves to significantly reduce cancer rates in Newark, as was evidenced by a study on cervical cancer in the city. This study found that “the ratio of in situ to invasive cervical cancer increased and decreased in a striking parallel with the provision and subsequent cessation of funding.”
Finally, it should be noted that cancer screenings are only the beginning of the battle for improving cancer outcomes for the un- and underinsured, as once cancer is diagnosed, these women receive surgery and initiate chemotherapy considerably slower than similar insured women. The next step is to ensure that said women can navigate through the health care system quickly and efficiently so that they receive and complete necessary treatment in a timely manner. In fact, one study noted that “failure to follow through with postoperative adjuvant therapy was the most important factor in determining recurrence-free survival.” To this end, patient navigators may prove to be beneficial. In their study on the effects of patient navigation on women diagnosed with breast cancer, Ferrante et al. found that “delay in breast cancer diagnosis and treatment after an abnormal screening mammogram is associated with larger tumor size, advanced disease state, and poorer survival.” A patient navigator is essentially a person who addresses patients barriers to care to ensure that they efficiently follow through with all recommended treatment. Ferrante et al. write:
The patient navigator focused on specific needs of the women and guided those patients through the healthcare system. For example, the patient navigator provided patients with emotional and social support; helped patients make appointments and arrive at scheduled appointments on time and prepared; facilitated applications for financial assistance; connected patients with resources and support systems; and facilitated interaction and communication with healthcare staff and providers.
At present, UMDNJ, under a grant from Susan G. Komen for the Cure North Jersey, offers a patient navigator through the Sister to Sister Program.
UMDNJ New Jersey Medical School Essex County
The Sister-to-Sister Navigator Program is a breast cancer outreach and patient navigation program benefiting underserved African-American women in Newark. Funding awarded from this grant helps to support a breast health navigator to educate and empower women to navigate the health care system and help them to overcome financial, communication, medical system and emotional/fear barriers in obtaining breast cancer screening, diagnostic, treatment, and follow-up services. The breast health navigator outreaches to over 1000 African-American women per year in the “trenches” of Newark, recruits 20 peer volunteers per year to enhance outreach activities, and provides navigation services to over 75 women per year with suspicious mammograms to ensure compliance with diagnostic and treatment services. The long-term goals of this program are to increase the percentage of women with breast cancers diagnosed at early stage at UMDNJ-University Hospital (UH), increase survival, and decrease mortality, thereby reducing the disparity in cancer burden suffered by African-American women of Newark.
The van and the navigator are moves in the right direction and could well prove to be the difference between life and death for many. The City of Newark, UMDNJ, and the Susan G. Komen for the Cure North Jersey are to be highly commended. The drive for patient navigator services coextensive with the increased mobile outreach of “Mammography in Motion” would be a natural next.
Editor’s note: The readership of this blog is somewhat self-selecting, and particularly well educated. Some degree of familiarity with health care, research and clinical methodology is almost presumptive. In that regard I rather fear that the importance of a patient navigator or liaison may be overlooked or underestimated. To that end, a personal experience may lend some perspective. A little over 2 years ago my 75 year old father became acutely ill, presenting as a possible stoke or transient ischemic attack (TIA) victim with some anomalies of note. While hospitalized, his ultimate diagnosis took approximately 3 weeks (a very very rare, sudden onset and always fatal brain disorder). He survived that diagnosis by only a week. As the doctors progressively strayed from Occam’s razor for an answer, I was able to immerse myself in the clinical research associated with his test results. Doing so, I was able to ask pertinent questions (”I’m sorry, it’s just that in all my years in medicine no one has ever thought to ask me for their Evans Ratio number”), was able to report observations of note regarding his condition, and early on, dispute and demand additional tests in light of a mis-diagnosis of Alzheimer’s and the prospect of my Father’s inappropriate release from care.
The point is, once I familiarized myself with the language, my legal training and research skills proved readily serviceable under the circumstances to the task at hand. Not everyone has that benefit. My adoptive family, for the most part void of formal education past high school, relied on me for such. I also functioned as their “translator.” And in the long periods between doctor visits beside my Father’s bedside, I was struck by how often that which seemed perfectly clear to me had been misconstrued by my family. I say this only because medicine is particularly complex, and the world is full of people who have not been trained academically for the understanding of academic complexity. Grappling with the prospect of death does not help. Under these circumstances, with so much on the line, a “Navigator” makes perfect sense, and I am not at all surprised at reports of its efficacy. It is simply not reasonable to think that patients will do (or do well) that which they do not understand.
