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Breast cancer screenings are up, but new guidelines could hurt outreach

Dr. Heidi Miller, (left) and breast health navigator Cherese Agard work at Family Care Health Center in the Forest Park Southeast neighborhood of St. Louis.
Durrie Bouscaren | St. Louis Public Radio
Dr. Heidi Miller, left, and breast health navigator Cherese Agard work at Family Care Health Center in the Forest Park Southeast neighborhood of St. Louis.

In the past six years, staffers at Family Care Health Center in St. Louis have doubled the number of women coming in for regular mammograms.

It’s part of a region-wide push for “breast health navigators”: women who reach out to other women who aren’t getting mammograms and frequently don’t have health insurance. Then, they figure out how to get them in the door.

Navigator Cherese Agard can tick the reasons she hears off of her fingers.    

“'I have to work, I can’t take another day off of my job, I’ve got my kids, there’s no one to keep my kids.' There are a lot of different things, and we try to work with them the best we can,” Agard said. “If it’s transportation issues, we try to assist them with that, with cab vouchers.”

Other times, the support system helps patients overcome a language barrier, find health coverage after a diagnosis, or simply offer emotional support.

This piece of health advice is pretty universal for middle-aged women: Get a regular mammogram. But when to start, and how often to go, isn’t as straightforward. Recent changes to federal recommendations have people like Agard concerned that conflicting information will undo the work they’ve done. And in the meantime, providers believe some of society’s most vulnerable women still aren’t getting the screenings they need.

“Some women mistakenly think a breast cancer diagnosis is a death sentence and it’s not. Success rates are high. But it’s directly dependent on how early you catch it,” said Dr. Heidi Miller, a primary care physician at Family Care who leads a regional work group of breast health navigators.  

In the fall of 2015, the American Cancer Society scaled back its recommendations for how often most women should receive a mammogram, citing the frequency of false-positive results.

The news came as a “punch in the gut,” said Susan Kraenzle, who manages supportive care at the Siteman Cancer Center at Barnes Jewish Hospital. “For those of us who have seen results from the nationally based screening program, we’ve watched deaths decline. You can line up the decrease in mortality with increase in screening,” Kraenzle said.

In the latest set of guidelines, the society recommends that women with an average risk for breast cancer have annual mammograms between the ages of 45 and 55, and then have a screening every other year. The U.S. Preventive Services Task Force has also reduced the frequency it recommends: every other year between the ages of 50 and 75.

But those rules don’t apply to every patient, Miller said. A family history, a sedentary lifestyle or even genes can put a person at a higher risk of breast cancer.

“I continue to be concerned about health-care disparities. Breast cancer can be more lethal in an African-American patient. There’s a higher level of triple-negative breast cancer in our African-American patients, and we need to make sure that we’re delivering the appropriate screening and treatment services to our patients as soon as possible,” Miller said.  

Until more personalized recommendations are available, Miller suggests talking to a doctor about your individual risks and taking steps to prevent cancer with a healthy lifestyle.  

Nedra Stevenson, a breast health navigator, stands by a mammography machine at Siteman Cancer Center in St. Louis.
Credit Durrie Bouscaren | St. Louis Public Radio
Nedra Stevenson, a breast health navigator, stands by a mammography machine at Siteman Cancer Center in St. Louis.

Nedra Stevenson, a breast health navigator at Siteman, said a relatively large number of women in St. Louis County are still not coming in for regular screenings, though they should. A grant from the Susan G. Komen Foundation covers the cost of a free mammogram program and a fleet of mobile vans, which provide about 4,000 screenings a year to women without health coverage.

"We have to reassure them that no matter what occurs, the navigators are here to assist and to help, and to make sure everything goes smoothly with financial (help) and comfort," Stevenson said. 

Now, Stevenson said she worries that the changing guidelines will have unintended effects on the women she’s trying to reach.

“We just got through to them to get their mammograms every year,” Stevenson said. “It’s just confusing. Some women get it, and some women that don’t get their mammograms, when they hear that, it’s going to steer them away from getting a mammogram done.”

Follow Durrie on Twitter: @durrieB

Note: An earlier version of this story included a typo in the spelling of the Susan G. Komen Foundation.