IF YOU are a middle-class woman in the American mainstream, it's likely that you will be reminded at least once a day that October is Breast Cancer Awareness Month.
Pink ribbons, the symbol of breast cancer survivors, are everywhere. This month's fashion and women's magazines boast "think pink" color themes and contain full-page ads for breast cancer charities. Through "cause-related marketing," manufacturers are appealing to consumers of everything from pajamas to vacuum cleaners by donating a percentage of sales to breast cancer research.
But if you are a middle-class woman in the American mainstream, you may not have to be reminded that it's Breast Cancer Awareness Month. You're already taking care of yourself by doing breast self-exams and getting regular mammograms.
What's more, it's often difficult for well-informed, educated women to imagine how anyone would not pay attention to their own breast health, considering the prevalence of the disease.
Such awareness campaigns, designed to reach a mainstream audience, may, for that very reason, miss those hard-to-reach populations who don't see themselves reflected in either the pages of Vogue or their local newspaper.
Statistics help tell the story of who is and who isn't aware of breast cancer. According to Maryland's Behavioral Risk Factor Surveillance System, 64.3 percent of women in the state report that they have had a mammogram.
That means that more than a third of Maryland women have not received mammograms - many because of fear, mistrust of the health care system or the lack of insurance or transportation. Isolated, stoical and often uninformed, they're likely to resist care unless an outreach worker can connect with them.
In an environment where women are often reluctant to care for themselves, the ability to gain others' trust is crucial. That's why a more personal, door-to-door strategy is called for to promote breast cancer awareness among low-income women in rural and urban areas and those for whom language barriers or cultural beliefs present obstacles to taking charge of one's own health care concerns.
In Washington County, a Make a Difference grant from the Maryland affiliate of the Susan G. Komen Breast Cancer Foundation supports a free screening clinic intended to reach low-income rural and urban women. The clinic, a collaborative effort of several government and nonprofit groups, is supported by the affiliate's two-year, $193,000 grant. It's one of 14 grants Komen awards for programs that focus on hard-to-reach populations.
