Carcinoma detection at the breast examination center of Harlem

Abstract

BACKGROUND Breast carcinoma is one of the leading causes of excess mortality rates in Harlem, an inner‐city neighborhood with the highest mortality rates and worst life expectancy in New York City. This study reports the results of a breast carcinoma screening and diagnostic program in Harlem. METHODS Retrospective review was performed of a database of 49,750 visits to the Breast Examination Center of Harlem from 1995 to 2000. During this period, 181 breast carcinomas were diagnosed in 178 women. The medical records of these 178 women were reviewed to determine the method of detection, stage, and treatment. RESULTS Among these women, 89% were black or Hispanic, 45% had no medical insurance, and 38% had incomes below federal poverty guidelines. Breast carcinoma stage, known for 167 carcinomas, was Stage 0 in 38 (23%), Stage I in 38 (23%), Stage II in 63 (38%), Stage III in 24 (14%), and Stage IV in 4 (2%). Fifty‐six cases (34%) were minimal breast carcinomas. Of 181 breast carcinomas, 122 (67%) were palpable and 59 (33%) were nonpalpable, detected only by mammography in asymptomatic women. Nonpalpable, as opposed to palpable, breast carcinomas were significantly more likely to be ductal carcinoma in situ (30 of 55 [54%] vs. 8 of 112 [7%], P < 0.0000001) or minimal breast carcinoma (39 of 55 [71%] vs. 17 of 112 [15%], P = 0.0000001) and were more likely to be treated with breast‐conserving surgery (47 of 56 [84%] vs. 76 of 110 [69%], P < 0.04). CONCLUSIONS A breast carcinoma screening and diagnostic program has been established in Harlem, a traditionally underserved area in New York City. Early, curable breast carcinomas were detected but outreach remains a challenge, particularly for the uninsured. Cancer 2002;95:8–14. © 2002 American Cancer Society. DOI 10.1002/cncr.10640

Breast Cancer Screening at the Breast Examination Center of Harlem

“…When comparing our results to the earlier experiences at BECH (Table 3) 3 , the most obvious difference is the earlier stage at diagnosis in the more recent study period and a lower percentage of patients presenting with clinically palpable tumors. Additionally, the majority of patients in this study period were diagnosed via percutaneous biopsy, reflecting the greater percentage of patients diagnosed via screening.…”

“…3 The number of screening mammograms performed per year increased in this recent 199 study, possibly reflecting the increasing population in Harlem. There was a higher rate of cancer diagnosis in the later period (39 cancers per year versus 32 cancers per year).…”

“…Consequently, access-enhancing strategies, which are the most effective type of patient-targeted intervention, are important components of health care delivery. Here we report on the Breast Examination Center of Harlem (BECH), a breast screening and diagnostic facility outreach program of Memorial Sloan Kettering Cancer Center (MSKCC) in Harlem, New York, NY, that was initially founded in 1979 and that has screened more than 200,000 women, As a follow up to an earlier report of the BECH's initial experience from 1995-2000 3 ; we now report on the subsequent experience from 2000-2008 and enquire whether the presence of this long-standing program in the New York City community of Harlem has made a significant impact in earlier detection of breast cancer.…”

Exploring the Role of Community Health Workers in Providing Cancer Navigation: Perceptions of African American Older Adults

“…They also have provided informal counseling, social support, health education, screening, detection, and basic emergency care (Rosenthal et al, 1998; Witmer, Seifer, Finocchio, Leslie, & O’Neil, 1995). By identifying and addressing barriers to adherence to cancer screening or treatment recommendations and working with patients to negotiate tailored plans of care, CHWs have improved care access and cancer screening behaviors, as well as reduced healthcare costs in minority communities, including Black and Hispanic communities (Earp et al, 2002; Liberman et al, 2002; Oluwole et al, 2003). However, it is unclear whether CHWs are able to effectively assist African American older adults, particularly those residing in rural areas, with multiple support issues related to cancer diagnosis and treatment, including the financial aspects of cancer care (Viswanathan et al, 2009; Wells et al, 2008).…”

Cancer Statistics for Hispanics, 2003: Good News, Bad News, and the Need for a Health System Paradigm Change

“…4 Among all those barriers, the lack of awareness toward cancer prevention and early detection issues and the lack of access to quality health care are the predominant obstacles to achieving adequate cancer health outcomes. In addition, some cultural characteristics, such as fatalism, fear of cancer diagnoses, and preconceived ideas, also contribute to those disparities.…”