Ambrosia Services

Down-home tactic may save lives

Lay advisers shown to boost mammograms in rural areas
Wednesday, September 06, 2006
Misti Crane
THE COLUMBUS DISPATCH

She makes a point of talking to other women about their breasts.

She stops them in grocery stores and at church.

She visits them in small groups at the beauty shop, or one-on-one in their homes.

Zawadi Yaashantawa marks her success with each of those women who ends up standing in front of an X-ray machine.

"The first thing I’ll say to a woman is, ‘Have you had your mammogram yet?’ " the 63-year-old Columbus woman said yesterday.

Despite the relative abundance of opportunities to get mammograms, even for poor and uninsured women, many go without.

Women are far more likely to have mammograms if other women teach them about mammography and push them to be screened, a study in today’s Journal of the National Cancer Institute shows.

The research is the first look at the role of socalled lay health advisers in the rural population and confirms previous studies of their impact on urban women, said Electra Paskett, lead author and associate director for population sciences at the Ohio State University Comprehensive Cancer Center.

Researchers randomly assigned 851 rural North Carolina women to two groups. Half had multiple visits from a health adviser.

After a year, 42 percent of the adviser group had mammograms, compared with 27 percent of the other women, a difference that amounted to 66 more mammograms.

Strides have been made in encouraging and financially supporting mammography, said LeighAnne Hehr, healthpromotions coordinator with the American Cancer Society’s Central Ohio region.

But disparities remain in poor, rural areas and can be helped significantly with the use of health advisers, Hehr said.

"Especially in Appalachia and rural areas, when you have a personal connection who says, ‘This is important and you need to do it,’ women are a lot more apt to do it."

Many women in these regions don’t even go to the doctor unless they’re already sick, so there is limited opportunity for medical professionals to remind them, Hehr said.

"There usually are resources available — it’s just knowing that they’re there," she said.

Yaashantawa has talked to women about breast cancer and mammography for more than a decade and currently is part of Ohio State’s four-yearold diversity-enhancement program.

Along with a paid nurse, doctor and health educator, a team of 18 volunteer health advisers in Columbus and Springfield reach out to minorities and other underserved groups in hopes of adding more diversity to clinical trials, said program Director Jaci Holland, who is a registered nurse.

A byproduct of the work is education about screenings that can reveal four common cancers: breast, cervical, colon and prostate.

The advisers are trained in basic anatomy, how cancer operates and what screening tools are available.

Some of the primary obstacles to women getting mammograms are lack of information, and fear — either of finding out they have cancer or of pain during the mammogram, she said.

In their study, Paskett and her colleagues found that very few women had been encouraged to get a mammogram by a physician or anyone else. Furthermore, many didn’t know about resources to get free or reduced-cost scans.

Yaashantawa said she encounters myriad reasons for women avoiding mammography.

Some women believe that surgery will make cancer spread or that radiation from the X-ray will cause cancer.

"There are a lot of old myths and superstitious nonsense," she said.

Some women just haven’t made their own health a priority and need some prodding.

One friend was 69 and had never had a mammogram, despite mounting pressure from Yaashantawa, who finished treatment for breast cancer earlier this year after discovering a sunflower-seedsize lump in her own breast.

"I said, ‘I’m coming to your house and I’ll take you.’ "

After the appointment, Yaashantawa said, "She said she didn’t want that mammogram, but she was tired of me getting on her nerves."

mcrane@dispatch.com

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posted by Cheryl Levesque @ 1:54 PM