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MODULAR MAMMOGRAPHY PROGRAM (MMP)

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. Eliminate Disparities by Bridging Gaps

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MODULAR MAMMOGRAPHY PROGRAM (MMP)

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  1. 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

  2. LEARNING OBJECTIVES • 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

  3. 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

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

  5. 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

  6. 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

  7. FDA-APPROVED MAMMOGRAPHY FACILITIES •Recent trend: • National decline by 6.0% {2001-04} • # ♀ needing screening GAO Report: Mammography – Current Nationwide Capacity: July 2006

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

  9. ACCESS BARRIERS • Lack of FDA-approved mammography facilities • Lack of insurance • Lack of knowledge of navigating the system

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

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

  12. MOBILE COVERAGE Counties remaining outside mobile coverage:

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

  14. 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

  15. SOPHIE TRANSPORT VAN Shown is a transport van equipped with a hydraulic lift system.

  16. SOPHIE TRANSPORT VAN The hydraulic lift allows the SOPHIE to be transported directly into a screening facility.

  17. SOPHIE UNIT • Access to Wheelchair Ramp • Minimal 36” Door Frame

  18. EQUIPMENT & SUPPLIES

  19. DARK TENT – BATCH PROCESSING

  20. BATCH PROCESSING

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

  22. 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

  23. 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

  24. NORTHWEST COUNTIES PP = Participating Provider

  25. SOUTHWEST REGION

  26. CENTRAL REGION

  27. NORTHEAST REGION

  28. SOUTHEAST REGION

  29. MEAN AGE: 57 Years ~ 14 ♀/ visit

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

  31. INSURANCE DISTRIBUTION

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

  33. Average distance ♀ wouldneed to travel (one-way)to obtain a mammogram:45.5 miles

  34. 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

  35. 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

  36. 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

  37. 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.

  38. 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

  39. 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).

  40. MMP STAFF • 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

  41. 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

  42. 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

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