Day in, day out—outreach pays off
Rebecca Schwaab Melgares
In the next closest thing to a house call, Native American women in one region of South Dakota were recently invited for a single-visit cervical and breast cancer screening in their area.
"By going out into the community and providing a much needed service, we were able to reach underserved patients and to see the effects of our work in a direct way we don’t see everyday," says Gene Herbek, MD, chair of the Department of Pathology and clinical laboratory services at St. Luke’s Regional Medical Center, Sioux City, Iowa. Dr. Herbek was one of three pathologists who participated in the CAP-initiated Native American See and Treat Single Visit Cervical and Breast Cancer Prevention Program.
"Working directly with the patients reminded me of what we’re doing on a daily basis with Pap tests and why we’re doing it," says Nuria Perez-Reyes, MD, director of cytopathology for Washington Pathology Consultants and Dynacare Laboratory, Seattle. "Although we can’t do this every day, it was exciting to work side by side with gynecologists, nurses, and nurse practitioners who were there. And, they were happy to have us there."
In two days last October, a team of health care providers examined 59 Native American women from the Aberdeen region of South Dakota as part of the cervical and breast cancer prevention program. On the medical team with Drs. Herbek and Perez-Reyes were Carol Ann Filomena, MD, director of cytopathology at Methodist Hospital, Indianapolis, and three cytotechnologists—Angela Curry and Michelle Errecart, both of Dynacare Laboratory, and Karen Allen, of Heartland Pathology, Omaha, Neb. Also on the team were one obstetrician-gynecologist, one nurse midwife, one radiologist, and several nurses.
The goal of the program was to encourage healthy behavior and conduct testing and followup in a single visit. From 1999 to 2000, only 20.8 percent of Native American women from the McLaughlin, SD, area had a Pap test, compared with 64 percent of women nationally. (Indian Health Service statistics show that Native American women have the highest incidence nationwide of cervical cancer and death due to cervical cancer.)
Each woman who participated in the screening was given a physical exam and the opportunity to receive a Pap smear and/or a mammogram with colposcopy and fine-needle aspiration followup as needed. Pap tests were stained and read within 25 minutes. Registered nurses consulted privately with each patient about her test results.
Dr. Filomena, who performed several fine-needle aspirations for the program, says, "It was a gratifying experience for both patients and physicians to be able to obtain test results almost immediately and provide same-day treatment to women who may otherwise have had to travel as much as 100 miles away for followup care."
From the 15 mammograms and eight fine-needle aspirations performed during the program, one woman was diagnosed with a fibroadenoma, and an elderly woman with a chest wall mass was found to have metastatic carcinoma from the lung. The latter was rushed to the nearest hospital, 100 miles away, in Bismark, ND, for treatment. "The whole team really felt like we were accomplishing what we had intended to accomplish when we were able to help this patient get the care she needed," Dr. Herbek says.
Of the 46 patients who had Pap tests performed, 15 percent had abnormal results—six showed dysplasia and one indicated ASCUS. Six colposcopies were performed. Drs. Herbek and Perez-Reyes were not surprised to find an increased incidence of dysplasia among the program participants. (In an average population, two to five percent of Pap tests typically are abnormal.)
Contributing to the program’s success were the Native American women in the McLaughlin community who went door-to-door weeks before the event to educate women about the importance of getting a Pap test and to schedule the appointments. "The pathologists serving the McLaughlin area were pleased and surprised we were able to attract so many women for the program. The personal outreach was a critical piece of this success," Dr. Herbek says.
The College developed the screening program with help from the American College of Obstetricians and Gynecologists, representatives from the state senators’ offices, health care providers in the Aberdeen area, Medicine for Humanity, and other medical professionals. More than 50 CAP members also volunteered. "We were gratified and overwhelmed by the response of our members," says Dr. Herbek, chair of the CAPCouncil on Public Affairs.
The program was funded in part by a grant from the American Cancer Society’s Midwest division. A mobile mammogram unit was provided by Avera McKennen Hospital, Sioux Falls, SD, with the help of the hospital’s clinical director of telemedicine, Henry Travers, MD. Dr. Travers, a pathologist, donated a microscope for the project. Cooper Surgical, Shelton, Conn., provided a colposcope, LEEP machine, and cryosurgery machine. Marconi Medical Equipment, Highland Heights, Ohio, lent the program view boxes to view the radiology slides from mammograms. And Leed’s Precision Instruments, Golden Valley, Minn., provided microscopes.
The College is planning two more Native American cervical and breast cancer prevention programs for 2002. To volunteer for a program or for more information, contact the CAP communications department at firstname.lastname@example.org.