KAREN CODJOE , MD, MPH, CLC

HEALTH OFFICERFAYETTE COUNTY

West Tennessee Cancer Mortality Disparity

1. DISCUSS CA NCER REG IST RY QUA NTITATIV E DATA

2. DISCUSS QUA LITATIV E DATA RELATED TO BREA ST CA NCER M ORTA LIT Y

3. DISCUSS P ROP OSA L TO A DDRESS BREA ST CA N CER M ORTA LITY DISPA RITY IN RURA L W EST T ENNESSEE

objectives

Tennessee Cancer Deaths Disparity

277 275261 264 256

271 264245 237 245

211 205 209 206 202 202 198 198 196 196

0

50

100

150

200

250

300

350

400

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Age

-Adj

uste

d Ra

te p

er 1

00,0

00

Year

Cancer Deaths by RaceTennessee, 2000-20092

Black White

78

121

217

58

81

119

137

46

0

50

100

150

200

250

Lung Breast Prostate Colorectal

Age

-Adj

uste

d Ra

te p

er 1

00,0

00

Cancer Incidence by Site and RaceTennessee, 2005-20091

Black

White

68

36

62

28

66

22 2217

0

10

20

30

40

50

60

70

80

Lung Breast Prostate Colorectal

Age-

Adju

sted

Rat

e pe

r 100

,000

Cancer Mortality by Site and RaceTennessee, 2005-20091

Black

White

Identify mortality to incidence ratio as sensitive indicator to detect breast

cancer disparity

7

County Race Count RateConfidence

IntervalCount Rate

Confidence Interval

M:I Ratio

Black 51 169.6 125.7-224.3 13 43.2 22.8-74.9 0.25White 103 129.9 105.6-158.5 19 21.1 12.6-33.8 0.16Black 30 104.2 69.8-150.0 15 53.9 29.8-90.1 0.52White 28 87.6 57.3-129.4 6 16.5 5.9-39.1 0.19Black 18 94.2 55.3-149.3 7 33.4 13.2-69.9 0.35White 52 94.7 70.2-125.6 15 24.9 13.7-42.7 0.26Black 36 132.9 92.9-183.9 16 60.3 34.4-97.7 0.45White 132 105.4 88.0-125.2 25 20.4 13.1-30.2 0.19Black 2992 120.9 116.5, 125.3 858 35.8 33.4-38.3 0.3White 18253 119 117.3-120.8 3527 22 21.2-22.7 0.18Black 120.5 118.9, 122.0 30.5 29.7-31.3 0.25White 123.6 123.1, 124.2 21.6 21.4-21.9 0.17

TN

US

Incidence Mortality

Fayette

Haywood

Lauderdale

Tipton

Breast cancer mortality to incidence ratio in TN exceeds US ratio, 4 rural West counties greatly exceeds TN

ratio.

Tennessee Departm

ent of Health

County Population Uninsured County Percent

Black %

Fayette 1399 419 29.9% 28%Haywood 1096 305 27.8 50.2 Lauderdale

1357 354 26.1 34.9

Tipton

2147 568 26.5 18.9

Shelby 33570 10650 31.7% 52.3

BRFSS data: Percentage of women over 40 reporting NOT having a mammogram in past two years:2005 Shelby 15.4% Southwest 38.7%2006 Shelby 22.6% Southwest 29.3%2007 Shelby 23.3% Southwest 22.6%2008 Shelby 14.8% Southwest 30.0%2009 Shelby 18.4% Southwest 27.4%2010 Shelby 16.8% Southwest 39.7%

Community Based Collaborative Effort Addressing Breast Cancer Disparities

in Four Rural Counties

TO UNDERSTAND AND ASSESS WHY BREAST CANCER MORTALITY RATES ARE

HIGHER AMONG AFRICAN AMERICAN WOMEN IN FOUR RURAL COUNTIES IN

WEST TENNESSEE

Project Aim

Plan and Approach

Developed focus group questionsDeveloped focus group work plan and

methodologyIdentified key stakeholdersRecruited focus group participantsImplemented focus group sessionsData analysisDisseminate focus group findings

Focus Group Questions

African American Women Why is breast cancer mortality high in rural west tn counties

among African American women? Do you know the reasons why some women don’t go for

screening?Community Lay Health Workers

What factors lead to poor health outcomes?Faith Based Organization Leaders

Does faith/religion have anything to do with how women perceive breast cancer or use services?

Medical Providers Why are there geographic gaps in the availability of health

care providers?

African American Women

Breast Cancer mortality is high among African American Women Lack of knowledge, delay in screening leads to late

diagnosisReasons why some women don’t go for

screening Transportation barriers, negative medical results

Messages women have been told about breast cancer Mammograms hurt, mammograms not necessary for

women with small breastsRecommendations on how to address the

problem Increase knowledge of area services, patient

navigators

Community Lay Health Workers

Breast Cancer mortality is high among African American women Secrecy of family health history,

Factors that lead to poor outcomes lack of insurance at the time of diagnosis, lack of

sustainability of local programsRecommendations on how to address the problem

Promote health care information, encourage f/u continuation of care

Statements that African American women believe, understand and act on regarding cancer Fear, aggressive/ proactive in your own health

Faith Based Organization Leaders

How does breast cancer affect African American women in your church: Supportive network, mistrust of health departments

Does faith have anything to do with how women perceive breast cancer or use services literal thinking , testimonials

Role faith leaders and communities play in overall health and wellness, illness, death Health ministries, provide congregations with easy access to

health informationHow can we work best with you on the issue that

affects your community church-church partnerships, church-health dept partnerships

Medical Providers

Breast cancer mortality is high among African American women Stage of diagnosis, missed health appointments

Factors that lead to poor outcomes Lack of trust in the health care system, lack of

knowledge regarding one’s health statusDescribe the availability of health care

services PCP vs health department

Causes of lack of access to breast cancer services Lack of funding, poverty

POLICY

Tennessee Breast and Cervical Cancer Screening Program has county specific guidelines for the distribution and utilization of funding in Fayette, Haywood, Lauderdale, and Tipton

Proposal

Women over 50 who have never had a mammogram

Target population

Community Partners

AHEC (Area Health Education Center)McKnight clinicStanton Community Health CenterLauderdale County Primary Care ClinicTipton County Primary Care ClinicBaptist Memorial Hospital System Research Center on Health Disparities ,

Equity and the Exposome at UTHSC

Area Health Education Center

Area Health Education Center (AHEC) received funding from Susan G. Komen Foundation to address breast cancer screening and treatment in Fayette county

Program components: trained lay health workers, churches, mobile mammography unit (Baptist Hospital)

County Population Uninsured County Percent

Black %

Fayette 1399 419 29.9% 28%Haywood 1096 305 27.8 50.2 Lauderdale

1357 354 26.1 34.9

Tipton

2147 568 26.5 18.9

Shelby 33570 10650 31.7% 52.3

BRFSS data: Percentage of women over 40 reporting NOT having a mammogram in past two years:2005 Shelby 15.4% Southwest 38.7%2006 Shelby 22.6% Southwest 29.3%2007 Shelby 23.3% Southwest 22.6%2008 Shelby 14.8% Southwest 30.0%2009 Shelby 18.4% Southwest 27.4%2010 Shelby 16.8% Southwest 39.7%

McKnight Clinic

Primary care clinic located in Somerville, Tn (Fayette County)

Source of referrals for breast cancer screening

Stanton Community Health Center

Federally qualified health clinic located in Haywood County

Source of referral for breast cancer screening

Lauderdale/Tipton County Primary Care Clinic

Located in county health departmentSource of referral for breast cancer

screening

Baptist Memorial Hospital

Susan G. Komen grant recipient for mammography services

Application required for means testing

Baptist Women’s Health CenterGrant Application Process

To be eligible for available grants at Baptist Women’s Health Center, a patient must:

Be uninsured Reside in Shelby, Tipton, or Fayette for the Komen Grant Reside in Shelby, Tipton, Fayette, DeSoto, or Tunica County for the Pink Ribbon Grant Meet financial criteria based on the current federal poverty guidelines Have a Physician   Instructions for applying:   Fill out the Grant application and submit with the application: Proof of residency. (MLGW bill, etc.) Please list all family members (including yourself).  Family members are person related by

birth, marriage, or adoption living together in the home along with the patient.  Also included are children who are full time students in an accredited college.

Proof of Income of all people living in household – Example: 3 check stubs, W2 form, income tax return for previous year or any state assistance documents

Driver’s license or Picture id. Please mail or fax completed applications to Lyn Sperling at (901) 226-0839.   Grant results will take 1 week to process. Grants are provided to the Baptist Memorial Hospital Foundation through Susan G. Komen

for the Cure, Breast Cancer Eradication Initiative, and Breast Cancer Relief Foundation.

Research Center on Health Disparities , Equity and the Exposome at UTHSC

Funding for community outreach500 survivors will meet @ UTCHS for a rally.

They will then go out into their community and encourage early screening and detection

Motto: ‘not my daughter and not on my watch”

Mortality Prevention Program

Modeled after Tennessee Department of Health PPI( Primary Prevention Initiative)

teams formed in Fayette, Haywood, Lauderdale and Tipton countiesTeam composition:

County health department staff Regional office staff Community partners

Project focused on reaching out to women over 50 in those counties through the churches and community events.

Mortality Prevention Program

Maintain contact with county specific partner organization for the referrals

Assist with logistics of obtaining mammogram

Assist with follow-up using the framework of TBCCS program

Challenges

Hard to reach populationPersonal Belief systemsFunding for mammographyLogistics for obtaining mammography