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  1. COMMUNITY INTERVENTION PLAN Christina Bookheimer Michelle Rowe Sandra Saylor Jackie Tiefenthal Joseph Urbanski

  2. Introduction Kent County which includes the city of Grand Rapids, Michigan has a high prevalence of breast cancer. In reviewing the data provided to us it was apparent that this is an issue that requires public health attention.

  3. Community Problem Statement Risk of developing breast cancer among 50-74 year old residents of Kent County, Michigan related to poor air quality, lack of screenings, and high unemployment rate as evidenced by age specific rate of diagnosis of 343, lower than average mammography units available in area, high rates of carbon dioxide 0.277, particulate matter 9.44, nitrogen dioxide 11.6, and air quality indicator of 32.7 as well as high unemployment rate of 12.1%

  4. Supporting Data • Kent County cancer incidence trend 2003-2007 was 370.6 age-adjusted to 124.5 • State of Michigan cancer incidence trend 2003-2007 was 6939.4 age-adjusted to 122.1 • 1,320 deaths and 7,340 new cases of breast cancer were reported for the year 2010 in Michigan • 50-74 year olds in Kent County with age specific rate of 343 • 50-74 year olds State of Michigan with age specific rate of 300.5 Michigan Department of Community Health, 2009 Michigan Cancer Consortium, 2010

  5. Supporting Data Screenings • Lowest rate for obtaining mammography in the United States is 50-59 years at 79.9% • Relatively large amount of females in Michigan live within 30-45 miles of a mammography unit • Kent County is shown to have 23 mammography units but this is much lower than other counties comparatively Centers for Disease Control and Prevention, 2010 Michigan Cancer Consortium, 2010

  6. Supporting Data Air Pollution • Air quality in Kent County is rated at 32.7 • Air quality for the United States is 32.0 • Kent County/Grand Rapids is 45th of the Top 101 Counties with the highest lead air pollution and particulate matter • Kent County/Grand Rapids is 76th of the Top 101 with the highest nitrogen dioxide air pollution • Kent County/Grand Rapids is 97th of the Top 101 with the highest carbon monoxide air pollution City Data, 2010

  7. Supporting Data Unemployment • One-third of individuals who stopped working and left a job that previously provided them with employer-sponsored health insurance became uninsured for six consecutive months • 57% of all adults say they have put off some sort of needed medical care over the past 12 months because of cost • Unemployment rate for Kent County/Grand Rapids is 12.1 as of March, 2011 • Unemployment rate for State of Michigan 11% Kaiser Commission, 2010 City Data, 2010

  8. Interventionsfor increasing timely screening for at risk women, women with limited or no health coverage and women who avoid screenings

  9. Education on Mammography • A mammogram is an x-ray picture of the breast • The National Cancer Institute recommends that women age 40 or older should have screeningmammograms every 1 to 2 years National cancer Institute, 2010

  10. DEVELOP OR SELECT EDUCATIONAL BROCHURES AND POSTERS WITH PHOTO IMAGES OF AGE-RELEVANT WOMEN • Posters and brochures on display/accessible on how to access advocacy services Center for Disease Control and Intervention, & Prudential Center for Health Care Research. (n.d.).

  11. Education on self breast exams (sbe) • A breast exam is a self-inspection of your breasts. During a breast exam, you use your eyes and hands to observe the appearance and feel of your breasts. • Breast exams may help identify potential breast problems. Mayo Clinic, 2009

  12. SAFETY OF MAMMOGRAM UNITS • Results from randomized clinical trials and other studies show that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74 • Getting a high-quality screening mammogram and having a clinical breast exam (an exam done by a health care provider) on a regular basis are the most effective ways to detect breast cancer early National cancer Institute, 2010

  13. Use Simple Educational messages and material • Target less educated and low income women Center for Disease Control and Intervention, & Prudential Center for Health Care Research. (n.d.).

  14. Preventative care for those with limited income or no health care coverage • Available support systems • Funding available to cover the screenings • Organizations that offer free screenings Center for Disease Control and Intervention, & Prudential Center for Health Care Research. (n.d.).

  15. Refer women based on their ethicticity and geographic area • Identify mammography units in particular areas • Use females only • Same race and age Center for Disease Control and Intervention, & Prudential Center for Health Care Research. (n.d.).

  16. Hours screening are available for the public • Offer flexible weekend and evening hours • Assist women to identify the clinic and mammography sites most conveniently located to their home or jobs Simi Valley Hospital, 2010

  17. Transportation to screenings • Identify pubic transportation and their geographic area • Organizations that provide transportation to screening sites Center for Disease Control and Intervention, & Prudential Center for Health Care Research. (n.d.).

  18. EVALUATION “Evaluation is the process of determining the value or worth of a program, course, or other initiative, toward the ultimate goal of making decisions about adopting, rejecting, or revising the innovation”(Virginia Tech, 2011).

  19. Outcome Measures Utilized • Knowledge • Behaviors, skills • Attitudes, commitment to action • Emotional well-being • Health status (epidemiologic measures) • Presence of health care system services and components • Satisfaction or acceptance regarding the program interventions • Presence of policy that allows, mandates, or funds • Altered relationship with physical environment Maurer & Smith, 2009

  20. WAS THE MESSAGE UNDERSTOOD? Did the intervention include clear information on the importance of mammography screening and action to be taken by women? Was the intervention tailored to the unique needs of specific age/racial/ethnic/geographic or other subgroups? Were information and other educational methods available in other languages for non-English speaking women?

  21. BREAST SELF EXAM still believes that BSE is a useful and essential screening strategy, especially when used in combination with regular physical exams by a doctor and mammography. About 20% of the time, breast cancers are found by physical examination rather than by mammography. It is recommended that all women routinely perform breast self-exams as part of their overall breast cancer screening strategy (, 2008). Evaluation: Do women know how to perform a breast self-exam?

  22. MAMMOGRAPHY Results from randomized clinical trials and other studies show that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74, especially for those over age 50

  23. EVALUATING FACILITIES Are radiation facilities conveniently located in the community? Are radiation facilities “user friendly”?

  24. Mammography Centers in Grand Rapids Michigan (MI) DMI Clinic - Carl J. Kubek 847 Parchment SEGrand Rapids, MI 49546 Kent Radiology P.C. - Northwest933 Three Mile Rd, N.W. Ste. 106Grand Rapids, MI 49544 Spectrum Hlth Hospitals Lemmen-Holton Cancer Pavilion145 Michigan NE Ste 4200Grand Rapids, MI 49503 East Beltline Advantage Health St. Mary's X-Ray1471 East Beltline NE Ste. 103Grand Rapids, MI 49525 MMPC Womens Imaging Center4069 Lake Drive SE Ste. 116Grand Rapids, MI 49546

  25. Mammography Centers in Grand Rapids (continued) Spectrum Hlth Hospitals Women's Hlth Center555 Mid Towne NE Ste 101Grand Rapids, MI 49503 Grand Valley Surgical and Diagnostic Ctr2680 Leonard N.E.Grand Rapids, MI 49525 Spectrum Health Hospitals-Betty Ford Breast Care Service550 Cherry Street SEGrand Rapids, MI 49503 Spectrum Hlth-South Campus - Betty Ford Breast Care Servs.80 - 68th Street S.E.Grand Rapids, MI 49548 Kent Radiology P.C.4340 Callander Dr SE Ste.102Grand Rapids, MI 49508 Spectrum Hlth Hosp Betty Ford Breast Care1840 Wealthy St. S.E.Grand Rapids, MI 49506 The Lacks Cancer Center at Saint Mary's Breast Services250 Cherry St. SEGrand Rapids, MI 49503

  26. Evaluation of Screening Hours • Women in the age group of 40+ will be able to identify at least two different facilities near their home and the hours they offer clients to have mammograms performed. • Patients will follow The National Cancer Institute recommendation that women of the age 40 or older should have screening mammograms every 1 to 2 years • Women Who are being regularly screened will identify their knowledge of radiation exposure from mammograms and notify their health care provider when needing other tests involving radiation.

  27. Evaluation: Preventative care for those with limited coverage or no health care coverage • Women in the community will be able to identify at least one support system available to them in their community or surrounding area. • Identify factors that increase a woman’s risk of breast cancer. • Personal History – Women who have had breast cancer are more likely to develop a second breast cancer. • Family History – A woman’s chance of developing breast cancer increases if her mother, sister, and/or daughter have been diagnosed with the disease, especially if they were diagnosed before age 50. • Genetic Alterations: Inherited changes in certain genes increase the risk of breast cancer. • Breast Density: Women who have a high percentage of dense breast tissue have a higher risk of breast cancer than women of similar age who have little or no dense tissue in their breasts.

  28. Preventative Care Continued… • Also included are; Reproductive and menstrual history, long-term use of menopausal hormone therapy, radiation therapy, alcohol, DES, body weight, and physical activity level (National Cancer Institute). • Identify available funding information for various screenings. • The Centers for Disease Control and Prevention (CDC) coordinates the National Breast and Cervical Cancer Early Detection Program. This Program provides screening services, including clinical breast exam and mammograms, to low-income, uninsured women through the Unites States (National Cancer Institute).

  29. Transportation Evaluation • How many people had access to necessary transportation services and were they used effectively • Identification of at least one transportation mode to and from screening facilities along with rates and times available for appropriate transportation. • Grand Rapids Trolley • Metro Cab • Kent County Bus Use of available resources such as to locate screening locations and services

  30. Safety Evaluation • Women will identify potential benefits of mammograms along with potential harms from screening. (False-Negative and False-Positive results) • Early detection of patients who do have breast cancer • Beginning of treatment as early as possible in the course of the disease process • Reduction in number of breast cancer deaths in women ages 40 to 74 • Regular screening average increased in area being studied. • Understanding radiation dosing and its involvement with other testing such as x-rays

  31. Safety Continued… • National Breast and Cervical Cancer Early Detection Program (NBCCEDP). • Provides high quality screenings and diagnostic services for; • Breast Cancer • Cervical Cancer • Women ages 40-64 • Treatment Referals

  32. Conclusion In conclusion this community intervention plan was developed related to breast cancer incidence in the target community of Kent County, Michigan. The group chosen was 50-74 year old female residents of this community. It was established that the risk of developing breast cancer for this group is above the state average. The core problems identified were related to air pollution/quality, access and knowledge of screenings available, and unemployment rate that could impact insurance coverage and cost of this diagnosis. An intervention plan with evaluation methods have been identified and supported with appropriate data.

  33. References • Accesskent. (2011). Women’s health network/breast & cervical cancer control program. As retrieved from http://www.Accesskent.Com/health/healthdepartment/health_promotion/womens_health.Htm • American Cancer Society (2011). Learn about breast cancer. Retrieved from • Breast Cancer. (2008). Breast self exam. Retrieved from • Breast Cancer Fund. Chemicals in air and water. Retrieved from • Center for disease control and prevention. (2008). Breast cancer screening services provided. As retrieved from http://www.Cdc.Gov/features/dsbreastcancer/ • Centers for Disease Control and Prevention. (2010). Vital signs: breast cancer screening • among women aged 50-74 years, United States, 2008. Retrieved from on June 14, 2011. • Center for disease control and intervention, & prudential center for health care research. (N.D.). The manual of intervention strategies to increase mammography rates [data file]. Retrieved from http://www.Cdc.Gov/‌cancer/‌nbccedp/‌pdf/‌prumanual.Pdf • City-Data. (2010). Kent County, Michigan. Retrieved from on June 16, 2011. • Kaiser Commission. (2010). Assessing the risk of becoming uninsured after leaving a job: a look at the data. Retrieved from

  34. References • Maurer, F. A., & Smith, C.M. (2009). Community/Public health nursing practice: Health for families and populations. St. Louis, MO: Saunders Elsevier. • Mayo Clinic. (2009). Breast exam. As retrieved from • Michigan Cancer Consortium. (2010). The cancer burden in Michigan: selected statistics_1992-2010. Retrieved from on June 15, 2011. • Michigan Department of Community Health. (2010). Cancer tables: Kent County female 1985-2007. Retrieved from on June 15, 2011. • Michigan Department of Community Health. (2009). Michigan critical health indicators: 2007. Retrieved from • National Cancer Institute. (2010). Mammograms. As retrieved from http://www.cancer/gov/cancertopics/factsheet/detection/mammograms • Simi Valley Hospital. (2010). Cancer services. As retrieved from • UcompareHealthCare and UcompareHolding. (2011). Mammography Centers in Grand Rapids Michigan. Retrieved from • Virginia Tech. (2011). Retrieved from