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Mobility brings awareness to doorstep
"When we started our mobile mammography program in 1988, it was almost like someone landing from another planet," says Vera Garofalo, MT, director of mammography services at The Ohio State University Medical Center, Arthur James Cancer Hospital and Research Institute in Columbus.
Women were not aware of the benefits of early detection of breast cancer. Also, there were not as many mammography sites as there are currently, mammograms were not covered by insurance companies, and they were expensive, she explains. The mobile unit outreach helped women understand the importance of being screened for breast cancer, and it helped them get into the habit of having regular mammograms.
"When we began screening women with the mobile unit, about 20% had been having mammograms, and 80% were having mammograms for the first time. Now it is completely reversed, with 20% having mammograms for the first time," says Garofalo.
The mobile mammography units at Ohio State travel to corporate sites, organizational sites such as the YMCA, and rural areas acting in partnership with the local health departments.
There was a 12% decrease in the state of Delaware’s breast cancer mortality rate from 1993 to 1997, which coincides with the operation of Mammography of Delaware, a mobile mammography screening unit and education campaign. "Directly it is not correlated to us, but indirectly it is because of the outreach initiative we do," says Kate McKenzie, RN, program manager for Mammography of Delaware in Wilmington, a partnership between the state of Delaware and Christiana Care Health Services.
The mobile mammography unit works with employers and organizations. The program currently is targeting seniors and the underserved population. One effort partners with Planned Parenthood of Delaware, which provides breast exams and pap smears, while Mammography of Delaware provides the mammograms.
When mobile mammography units travel to a site, all women benefit — whether or not they are screened for breast cancer at that time, says McKenzie. First there is the visual reminder of the van, which is purple and white with a picture of a woman with arms crossed over her chest. Also, corporate managers can select from various educational programs for employees.
For work sites where women aren’t given time off to attend an educational session, Mammography of Delaware sets up a display booth in the break room. At the booth, women can pick up brochures on breast health and talk to someone who can discuss breast cancer and the benefit of having annual mammograms and doing monthly breast self-exams.
Companies also have the option of selecting an educational program such as Breast Health 101, which explains the basics of a breast self-exam, or Breast Health 202, which includes information on the diagnosis and treatment of breast cancer. "Sometimes companies will allow us to attend their safety meeting or staff meeting to present the information," says McKenzie.
Education has changed during the 11 years the mobile unit from Ohio State has been traveling to corporations, senior centers, and community sites because attendance at educational sessions began to decline after a few years.
"The big push in the beginning was education on early detection and how to do a breast self-exam. We would do extensive presentations on breast health and then sign women up for mammograms," says Garofalo. Now X-ray technicians pass out shower cards on breast self-exams and briefly go over the information. At some sites, educational sessions are offered every other year.
Teaching often is most successful if tailored to the needs of the group, says McKenzie. At senior centers and sometimes at churches, people are invited to play breast health bingo. Words like "mammography" replace the letters and numbers on a bingo card.
While people search their bingo card for the word, the nurse conducting the game explains the meaning of the word. Also, the nurse gives a short talk before the game and a brief review of the material once the game has been played several times.
Many times, an organization will provide education on breast health rather than having staff from the mobile van do it, says Karen Spears, LVN, mobile screening coordinator at University of Texas MD Anderson Cancer Center in Houston. Some corporations have a medical department that oversees the education portion.
Other organizations provide a nurse to give breast exams and teach the technique at the time of the mammograms. However, no matter what education is provided, women also see a video on breast self-exams while waiting in the reception area on the coach for their mammogram.
Mobile mammography removes the excuses that many women have for not getting a mammogram. "Women tell us that if we didn’t come to their work site, they might not have a mammogram or they wouldn’t be as consistent in getting it done," says Garofalo. Yet consistency is what makes a mammogram beneficial. "Having your annual mammogram every 10 years is not at all beneficial," she says. (For information on scheduling and tracking, see article on p. 22.)
For more information on providing breast cancer screening and education through mobile units, contact:
• Vera Garofalo, MT, Director of Mammography Services, The Ohio State University Medical Center, Arthur James Cancer Hospital and Research Institute, 4019 West Dublin-Granville Road, Columbus, OH 43017. Telephone: (800) 240-4477. Fax: (614) 293-6560. E-mail: firstname.lastname@example.org.
• Kate McKenzie, RN, Program Manager, Mammography of Delaware, P.O. Box 1668, Wilmington, DE 19899. Telephone: (800) 654-0606 or (302) 428-2841. Fax: (302) 428-4527. E-mail: email@example.com.
• Karen Spears, LVN, Mobile Screening Coordinator, University of Texas MD Anderson Cancer Center, Mobile Mammography, 1515 Holcombe Blvd., Box 57, Houston, TX 77030. Telephone: (713) 745-4000. Fax: (713) 745-4055.