Awareness for all

October 21, 2003|By Stephanie Shapiro

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.

Certain groups of women require a more culturally sensitive approach to breast cancer awareness by health care practitioners, says Abby Karlsen, Komen Maryland's grants and education program manager.

For example, among Maryland's Russian-speaking population, Ashkenazi Jewish women are at higher risk for breast cancer and can be difficult to reach, Ms. Karlsen says. One Komen grant supports the work of bilingual outreach workers who work with teens as well as adults. If young adults are aware of the importance of breast health, they "can make the case" to their mothers, Ms. Karlsen says.

At the conclusion of a free Make a Difference clinic held in Smithsburg last month, nine clients who may have stayed home without the efforts of an outreach worker had received clinical breast exams and had viewed a breast health video and a primer on the importance of early detection. A courtesy van driver supplied by the clinic has ferried several patients to and from Washington County Hospital for their mammograms.

If they require but are not eligible for free follow-up care, the women will be referred to Breast Cancer Awareness-Cumberland Valley, which connects them to alternative resources.

For some, breast cancer awareness comes the hard way, making it all the more crucial. After losing her insurance, Katherine Canfield of Sharpsburg saw an ad for the Komen-supported clinic. An exam and a mammogram led to a breast cancer diagnosis. Ms. Canfield has since received follow-up treatment arranged by Make a Difference collaborators.

"I know a lot of people are not going to take advantage of it, you know what I mean?" says Ms. Canfield, referring to the screening project. "Maybe they're just like me and think, `It's not going to happen to me.' I always wonder about women who had breast cancer. And, phew! I found out."

Stephanie Shapiro is a reporter for The Sun.

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