Julie Zenger Hain, Ph.D., FACMG

Department of Clinical Cytogenetics

Oakwood Hospital & Medical Center

Unidas por la Salud: A Comprehensive Breast Cancer Program for Women in

Southwest Detroit

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Unidas por la Salud United for Health

These slides are the property of the presenter, do not duplicate without express written consent.

Unidas por la Salud United for Health

Goal 1: Increase awareness of breast cancer risk among women in Southwest Detroit. Goal 2: Increase proportion of breast cancer diagnosed at earlier stages among women in Southwest Detroit Goal 3: Reduce financial barriers for timely and complete breast cancer screening follow-up and treatment among women of Southwest Detroit Goal 4: Increase awareness of breast cancer risk factors among women and promote education for women at increased risk in Southwest Detroit to seek appropriate services through their healthcare professional

These slides are the property of the presenter, do not duplicate without express written consent.

Genomics Objectives G1: Increase the proportion of women with a family history of breast and/or ovarian cancer who received genetic counseling

Health People 2020

These slides are the property of the presenter, do not duplicate without express written consent.

These slides are the property of the presenter, do not duplicate without express written consent.

These slides are the property of the presenter, do not duplicate without express written consent.

Primary Focus

• Hispanic Women in Southwest Detroit

• Women under age 40 and over age 64

These slides are the property of the presenter, do not duplicate without express written consent.

Why Women in Southwest Detroit?

• 57.2% of the population is Hispanic origin • Medically underserved, high rates of unemployment and poverty &

lack access to healthcare • Breast cancer is the most commonly diagnosed cancer among

Hispanic women & the leading cause of cancer death • Breast cancer is diagnosed less often among women of Hispanic

origin but more frequently at a later stage • Hispanic women are about 20% more likely to die of breast cancer

than non-Hispanic women at a similar age and stage – Lower utilization of screening tests – Disparities in access to care and treatment 2010 US Census and Data Driven Detroit ACS CA Facts & Figures for Hispanics/Latinos

These slides are the property of the presenter, do not duplicate without express written consent.

Why Women in Southwest Detroit?

• 57.2% of the population is Hispanic origin • Medically underserved, high rates of unemployment and poverty

& lack access to healthcare • Breast cancer is the most commonly diagnosed cancer among

Hispanic women & the leading cause of cancer death • Breast cancer is diagnosed less often among women of Hispanic

origin but more frequently at a later stage • Hispanic women are about 20% more likely to die of breast cancer

than non-Hispanic women at a similar age and stage – Lower utilization of screening tests – Disparities in access to care and treatment 2010 US Census and Data Driven Detroit ACS CA Facts & Figures for Hispanics/Latinos

These slides are the property of the presenter, do not duplicate without express written consent.

Why Women in Southwest Detroit?

• 57.2% of the population is Hispanic origin • Medically underserved, high rates of unemployment and poverty &

lack access to healthcare • Breast cancer is the most commonly diagnosed cancer among

Hispanic women & the leading cause of cancer death • Breast cancer is diagnosed less often among women of Hispanic

origin but more frequently at a later stage • Hispanic women are about 20% more likely to die of breast cancer

than non-Hispanic women at a similar age and stage – Lower utilization of screening tests – Disparities in access to care and treatment 2010 US Census and Data Driven Detroit ACS CA Facts & Figures for Hispanics/Latinos

These slides are the property of the presenter, do not duplicate without express written consent.

Why Women in Southwest Detroit?

• 57.2% of the population is Hispanic origin • Medically underserved, high rates of unemployment and poverty &

lack access to healthcare • Breast cancer is the most commonly diagnosed cancer among

Hispanic women & the leading cause of cancer death • Breast cancer is diagnosed less often among women of Hispanic

origin but more frequently at a later stage • Hispanic women are about 20% more likely to die of breast cancer

than non-Hispanic women at a similar age and stage – Lower utilization of screening tests – Disparities in access to care and treatment 2010 US Census and Data Driven Detroit ACS CA Facts & Figures for Hispanics/Latinos

These slides are the property of the presenter, do not duplicate without express written consent.

Why Women in Southwest Detroit?

• 57.2% of the population is Hispanic origin • Medically underserved, high rates of unemployment and poverty &

lack access to healthcare • Breast cancer is the most commonly diagnosed cancer among

Hispanic women & the leading cause of cancer death • Breast cancer is diagnosed less often among women of Hispanic

origin but more frequently at a later stage • Hispanic women are about 20% more likely to die of breast cancer

than non-Hispanic women at a similar age and stage – Lower utilization of screening tests – Disparities in access to care and treatment 2010 US Census and Data Driven Detroit ACS CA Facts & Figures for Hispanics/Latinos

These slides are the property of the presenter, do not duplicate without express written consent.

Why Under Age 40 & Over Age 64?

• Breast & Cervical Cancer Control Program (BCCCP)

– Services women 40-64 years of age

These slides are the property of the presenter, do not duplicate without express written consent.

Unidas por la Salud United for Health

Goal 1: Increase awareness of breast cancer risk among women in Southwest Detroit. Goal 2: Increase proportion of breast cancer diagnosed at earlier stages among women in Southwest Detroit Goal 3: Reduce financial barriers for timely and complete breast cancer screening follow-up and treatment among women of Southwest Detroit Goal 4: Increase awareness of breast cancer risk factors among women and promote education for women at increased risk in Southwest Detroit to seek appropriate services through their healthcare professional

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Unidas por la Salud

Patient Care Expense • Clinical Breast Exams • Mammography • Office visits • Genetic risk assessments • Follow-up patient care

– Ultrasounds – Biopsies – Follow-up mammograms – MRI

• Transportation • Interpreters

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American Cancer Society’s Promotoras de Salud Program

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Oakwood’s Faith-based Outreach Program

These slides are the property of the presenter, do not duplicate without express written consent.

These slides are the property of the presenter, do not duplicate without express written consent.

These slides are the property of the presenter, do not duplicate without express written consent.

These slides are the property of the presenter, do not duplicate without express written consent.

These slides are the property of the presenter, do not duplicate without express written consent.

• Personal history of: Breast cancer Ovarian cancer If Yes, age at diagnosis: _________ • Current age • Age at first menstrual period • Age at first live birth • Have you ever had a breast biopsy? If Yes, was atypical hyperplasia found under the microscopy? • Race/Ethnicity • Do any of these family members have a history of breast cancer: Mother – Age of onset: Sister(s) – Age of onset: Daughter(s) – Age of onset: • Do you have any of the following family history? Female breast cancer diagnosed under age 50 Male breast cancer diagnosed at any age Ovarian cancer diagnosed at any age Pancreatic cancer diagnosed at any age Colon cancer diagnosed under the age of 50

These slides are the property of the presenter, do not duplicate without express written consent.

These slides are the property of the presenter, do not duplicate without express written consent.

Process Flow

Grassroots Promotoras

Covenant

Clinical Breast Exams

Midwest

Mammograms

Breast Care Center-

Dearborn

Diagnostics

These slides are the property of the presenter, do not duplicate without express written consent.

Process Flow

Grassroots Promotoras

Covenant

Clinical Breast Exams

Midwest

Mammograms

Breast Care Center-

Dearborn

Diagnostics

These slides are the property of the presenter, do not duplicate without express written consent.

Unidas por la Salud United for Health

Goal 1: Increase awareness of breast cancer risk among women in Southwest Detroit. Goal 2: Increase proportion of breast cancer diagnosed at earlier stages among women in Southwest Detroit Goal 3: Reduce financial barriers for timely and complete breast cancer screening follow-up and treatment among women of Southwest Detroit Goal 4: Increase awareness of breast cancer risk factors among women and promote education for women at increased risk in Southwest Detroit to seek appropriate services through their healthcare professional

These slides are the property of the presenter, do not duplicate without express written consent.

Unidas por la Salud United for Health

Goal 1: Increase awareness of breast cancer risk among women in Southwest Detroit.

• Strong partnership established/providers trained • Unidas por la Salud programs promoted (English and Spanish) • 15 Promotoras culturally trained to educate women on breast health • Exceeded project program goal of 700 women impacted

• 1,109 women participated

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Unidas por la Salud United for Health

Goal 2: Increase proportion of breast cancer diagnosed at earlier stages among women in Southwest Detroit

• Provided 40 clinical breast exams and referred 149 to BCCCP • Provided 14 digital mammograms and 2 biopsies (benign lesions)

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Unidas por la Salud United for Health

Goal 3: Reduce financial barriers for timely and complete breast cancer screening follow-up and treatment among women of Southwest Detroit

• 14 mammograms • 15 ultrasounds • 1 MRI • Referred 149 women to BCCCP for mammograms • 2 biopsies

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Unidas por la Salud United for Health

Goal 4: Increase awareness of breast cancer risk factors among women and promote education for women at increased risk in Southwest Detroit to seek appropriate services through their healthcare professional

• Promotoras and provider education • 30+ identified women/family at higher risk • 7 individuals seen for Genetic Counseling • 1 Mammogram and 1 MRI for woman <40 years of age • 0 referrals for chemoprevention of breast cancer

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Unidas por la Salud United for Health

Lessons Learned

• Promotoras de Salud a successful program • Provider education/implementation impacted by available

follow-up care • Underutilization of available Federal/State funded programs • Follow-up care involved care at facility requiring legal ID • Risk Assessment – follow-up appointments poorly attended • Limited importance on breast health when dealing with acute

medical issues, poverty, and unemployment

These slides are the property of the presenter, do not duplicate without express written consent.

Julie Zenger Hain, Ph.D., FACMG

Department of Clinical Cytogenetics

Oakwood Hospital & Medical Center

Dearborn, MI

313.593.8483

zengerj@oakwood.org

These slides are the property of the presenter, do not duplicate without express written consent.