So Where Do Low-Income Women Go for Breast Cancer Screening?

I appreciated all the views from yesterday’s evening blog post. There were comments that agreed with me and those that did not. The amazing thing is that all were respectful and that was a gift for all of us. A great question asked by one of the readers named Lissa was this: Where do women who are 40 or older and are low-income with no insurance go for early detection and screening of breast cancer.”

Excellent question! It’s a great opportunity to offer this information and encourage people to have information about choices that are available for women’s health. So here goes:

In 1993 congress approved legislation that gave categorical funds for breast and cervical cancer screening. They made the funding available to all 50 states, the District of Columbia, 5 U.S territories and 12 federally recognized tribes – including Hopi Tribe and Navajo Nation.

The rationale was simple – finding both of these diseases early saves millions of dollars in health costs and lives – cervical cancer is 100% preventable and early detection of breast cancer yields a 95% survival rate. This program is called the National Breast and Cervical Cancer Early Detection Program. The program is run by each state and available for direct services through hospitals, health centers and clinics, and visiting nurse associations. It is specifically for women who are 250% of poverty level and below – to put that into context it means that a woman with a family of 6 can make just under $75,000 a year to be eligible. The limits are according to income and family size.

The program has grown through the years to include funding not only for screening but also for diagnostic service and finally in 2003 the funds expanded to include treatment – a legislative action we had all been waiting for. The parameters for the program are that a woman has to be 40 years old or above; at or below 250% of poverty level; and a citizen of the United States. It is a great program and has screened literally millions of women and saved millions of lives through this early detection. The funding is also available to women under 40 for cervical cancer screening as it is proven that finding and removing the lesions that can grow into cervical cancer through pap tests is life-saving.

I’ve worked in this program off and on since 2000 in both Massachusetts and Arizona. We are currently at a different place in Massachusetts where we have undergone healthcare reform so it is constantly in a state of change, but that’s another blog post. You can find more information here: http://www.cdc.gov/cancer/nbccedp/. But what is critical to remember is that there are other funds beyond Planned Parenthood available to help low income women. Besides this program, there are Federally Qualified Health Centers throughout the nation. FQHC’s (as they are lovingly called) are funded to provide care for the uninsured and under insured in both urban and rural areas. They serve disparate populations and the ones I’ve worked with do it extremely well with caring providers, nurses and social workers. I have included a fact sheet here: https://www.cms.gov/mlnproducts/downloads/fqhcfactsheet.pdf that will tell you more about these centers.

We do not have a perfect health system, there is a lot of work to do. But there are organizations that offer comprehensive care to women and do it well indeed. Thanks for reading – please join the conversation! Also help spread the word! If you posted the Defense post of yesterday on your wall, post this one as well so people can learn more and have better talking points. For information on where the program is available in your state click here

A Logical Defense of Komen aka What’s the Fuss All About Anyway?

This morning I defended arranged marriages and a mere twelve hours later, I’ve got another defense going! Here’s why:

Planned Parenthood is all a twitter! The Susan G. Komen for the Cure has pulled funds from the organization and Planned Parenthood is outraged!

For context I need readers to understand that I am a public health nurse who has worked for the past 10 years in preventive health, specifically breast and cervical cancer screening. I have worked in both Arizona and Massachusetts with low income women who are uninsured. Many of the health centers that I have been connected with receive Komen funds to work with this population of women. Rarely a day goes by where I don’t speak to someone on the phone who either needs to be screened or has breast cancer and cannot pay for treatment. This is a travesty.

“This money has saved thousands of women’s lives!”  is the rallying cry of Planned Parenthood in the wake of recent pulling of funds. Really? While I agree that since 2005 they have referred around 6,400 women for mammograms (a key to early detection of breast cancer) Planned Parenthood does not have the facilities anywhere in the nation to do mammography. Planned Parenthood does not focus on women over 50 where 95% of breast cancers occur. They cannot give direct services in relation to screening for breast cancer. It’s not what they are about.

Created for the love of a sister who died of breast cancer, the Susan G. Komen for the Cure mission is clear: “eradicate breast cancer by advancing research, screening, care and education.”  Their grant-funding reflects their mission and those who apply for their grants have to demonstrate a clear commitment to advancing the mission. I know. I have written several grants to the foundation and they go through a rigorous review process. (I’m happy to say the grants were funded!) The grant funding that people receive through Susan G. Komen for the Cure almost always goes to disparate populations to increase screening and early detection and decrease disparities that are present in our health care system. Anyone who ever receives grant funding knows that there is no guarantee of being funded forever. Funders can and do pull funding all the time for a lot worse reasons then being under a congressional investigation. And grant funding has always been politically motivated.  The money in question is almost $700,000, a minuscule percentage of the annual budget of Planned Parenthood of over a billion dollars.

But more than that, the reality is that Planned Parenthood doesn’t do breast cancer research or care. They serve a young population and focus on reproductive health. They are only able to offer one of the three prongs of early detection of breast cancer (clinical breast exams)and current research does not support clinical breast exams as an effective means to detect breast cancer. All told, there are thousands of other places that do reflect the mission of Susan G. Komen for the Cure, they are serving the underserved and they are desperate for funds.

Let’s look at the mission statement of Planned Parenthood: “Believes in the fundamental right of each individual, throughout the world, to manage his or her fertility, regardless of the individual’s income, marital status, race, ethnicity, sexual orientation, age, national origin, or residence. We believe that respect and value for diversity in all aspects of our organization are essential to our well-being. We believe that reproductive self-determination must be voluntary and preserve the individual’s right to privacy. We further believe that such self-determination will contribute to an enhancement of the quality of life and strong family relationships.”  There is nothing in this mission statement that demonstrates a commitment to eradicating breast cancer. Nothing to show any sort of commitment to early detection and screening. Nothing that would correlate with a foundation dedicated to not just finding a cure for breast cancer, but also finding the cause.

It is also critical to look at the prevalence of breast cancer. Breast cancer is most common in women over 50 years old. In fact, only 5% of breast cancers occur in women under 40!* Now how many 50 year olds do you know who are going for reproductive health visits to Planned Parenthood? Maybe then, the question to ask is not “Why are they pulling funding?” but “Why did they fund in the first place?”

In light of these facts it is illogical for Susan G. Komen for the Cure to continue funding Planned Parenthood for breast cancer screening and detection. Pure and simple, this is not where the money belongs – other organizations do it better and more seamlessly. If you want to fight for something, pick an issue that makes sense – like fighting for more funding for preventive care for the uninsured! Now that makes sense.

Bloggers Note: I was incorrect in my statement about breast cancer awareness information on the website of Planned Parenthood and the information is clear and factual. I hold to my original defense on this being an inappropriate place to go for breast cancer information and emphasize that most patients are in their teens to early twenties.

*American Cancer Society. Breast Cancer Facts and Figures 2011-2012. Atlanta, GA: American Cancer Society, 2011.