‘I’ve never been treated so well’: Same-day cancer screening program helps reduce barriers
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While on-site at a same-day cancer screening program he helped to implement, Timothy Craig Allen, MD, JD, FCAP, came across a crying woman.
“I thought perhaps she had gotten some bad news,” Allen, professor and chair in the pathology department at University of Mississippi Medical Center, told Healio. “I asked her if I could help her, but it turned out she was crying out of happiness. She said, ‘I’ve never been treated so well.’ That really struck me.”
Many women assume they will be treated with respect and consideration during a breast or cervical cancer screening. In fact, some same-day screening programs have been likened to a day at a spa.
However, for uninsured women or those in underserved communities — such as in Mississippi, where rates of late-stage breast, cervical and oropharyngeal cancer are among the highest in the nation — such services are not a given, nor are same-day results.
“A lot of our issues stem from socioeconomic factors in our state, with people not having insurance or being unable to afford insurance,” Jimmie Wells, RN, MSN, OCN, oncology survivorship navigator at St. Dominic Hospital in Jackson, Mississippi, told Healio. “Some of it, I think, is also a lack of knowledge about available resources. A lot of factors play into why these women are being diagnosed at such late stages and not getting routine care.”
Other barriers to care may include difficulty traveling from remote parts of the state, taking time off from work and finding child care. These challenges multiply when a patient has to return for a diagnostic test.
To address these barriers, the College of American Pathologists (CAP) Foundation developed See, Test & Treat, a free, same-day screening and health education program aimed at decreasing disparities in preventable cancers.
The program — adapted for use among uninsured and underserved women in the Jacksonville Metropolitan area of Mississippi — provides free mammograms, Pap tests, pelvic exams and oral cancer exams to participants, who receive results within 2 hours. Those with abnormal findings have an opportunity to schedule a follow-up appointment with a federally qualified health center prior to leaving.
Providers educate women during their consultation on cancer screenings. The educational component continues upon arrival at the screening site waiting room, where participants can choose from a variety of health activities, including demonstrations of yoga, Zumba and healthy cooking.
“We have a strong team of providers and students who volunteer their time for this program,” Wells said. “We really make a concerted effort to show that these women are special, and we make sure they feel that way.”
Results in Mississippi
Researchers led by Michelle S. Williams, PhD, MSPH, MPH, MCHES, assistant professor in the department of global and community health at George Mason University, evaluated the effect of the program on participants’ knowledge about cancer, self-efficacy for obtaining health care, and intentions to modify their health behaviors.
Participants were recruited through advertising in churches, health care centers and social media. Those with young children had the option of receiving child care.
Of 72 women who met screening eligibility criteria — determined using American Cancer Society guidelines — 53 underwent screening and 52 completed an evaluation survey.
When interviewed about their experience, most participants said they attended See, Test & Treat because they wanted a free cancer screening and could receive same-day results.
“Several women talked about how they drove from far away to get to Jackson to attend a screening session,” Williams told Healio. “Some said they came in the night before and stayed with a friend because they wanted a screening and weren’t able to access it otherwise.”
Most participants also said the health education activities had a significant effect on their understanding of the cancers for which they were screened and on their self-efficacy for pursuing routine check-ups.
All those with abnormal test results were scheduled for follow-up appointments. These included 18 women with abnormal mammogram results, 15 of whom underwent diagnostic mammograms. Based on the diagnostic mammograms, three women required biopsies; all had benign results. Two participants who underwent oral cancer exams had abnormal results and were referred for treatment. Although none of the 44 Pap tests were abnormal, 14 women were diagnosed with trichomonas and referred for treatment.
Creating a ‘health care home’
Gene Herbek, MD, created the See, Test & Treat Program nearly 20 years ago to help Native American women at the Standing Rock Reservation in his home state of Nebraska, according to Allen. At the time, Native American women had the highest cervical cancer rates in the country, as well as one of the lowest survival rates.
“It grew from that first program to what it is today; the CAP Foundation is now in charge of the See, Test & Treat Program, and provides direction and grants to support this,” Allen said. “They see the Mississippi program that Jimmie is heading up and Dr. Williams has been so involved in as a highlight of success.”
Medical students and providers volunteered their time to conduct screenings. Williams said this was a big advantage, both for the patients and the future clinicians.
“I think it was a benefit for everyone that we caught these medical students and nursing students while they were still in school, so they could have that experience and see the benefit in terms of diagnosis and treatment,” Wells said. “The other piece that makes us such a success is our community partners, who enable us to not only give them services on that day and their results, but also to follow up and help establish a health care home in their community. We don’t just throw them back into the wind.”
When surveyed about what they liked about the program, the women cited same-day screening results and noted that the staff treated them with respect.
The CAP Foundation has begun to use some of the Mississippi program’s approaches as examples of how the program can succeed, Wells said.
“CAP has actually used the services we offer as a model,” she said. “They have created a toolkit based on a lot of the things we offer in Jackson. Dr. Allen and I have discussed the possibility of making this program something we can take to different areas of the state.”
The same-day results provided through the program are more than just convenient, Allen said. They provide important, timely information for women who may be concerned about a possible cancer.
“To the extent that these women are found to not have any significant problems, they can go home relaxed, relieved and feeling good,” he said. “If we do find something, hopefully it is caught before it becomes cancer, or if it is cancer, it’s one that is in a very early stage where it can be very easily treated or maybe cured.”
References:
George Mason University College of Health and Human Services. Program seeks to reduce preventable cancers with free screening, same-day results, health education. Available at: chhs.gmu.edu/news/2021-07/program-seeks-reduce-preventable-cancers-free-screening-same-day-results-health. Accessed Aug. 11, 2021.
Williams MS, et al. J Canc Educ. 2021;doi:10.1007/s13187-021-02060-9.
For more information:
Timothy C. Allen, MD, JD, FCAP, can be reached at University of Minnesota, 2500 N. State St., Jackson, MS 39216; email: tcallen@umc.edu.
Jimmie Wells, RN, MSN, OCN, can be reached at St. Dominic’s Hospital, 969 Lakeland Drive, Jackson, MS 39216; email: wells2135@bellsouth.net.
Michelle S. Williams, PhD, MSPH, MPH, MCHES, can be reached at 4400 University Drive, Fairfax, VA, 22030; email: mwill29@gmu.edu.
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