SummaryBetween 1995 and 2002, the Contra Costa Breast Cancer Partnership aimed to reduce disparities in breast cancer–related health outcomes for low-income and minority women by developing culturally appropriate outreach and education designed to reduce the stigma surrounding breast cancer, encourage screening, and secure access to affordable treatment. Key components included forming population-specific task groups, awarding grant funds, sponsoring community-wide programs to promote screening, and coordinating subsidized treatment. The program led to enhanced access to breast cancer screening and earlier detection, particularly among African-American and Hispanic women.Moderate: The evidence consists of pre- and post-implementation comparisons of the percentage of African-American and Hispanic women with breast cancer who were diagnosed at an early stage, and post-implementation data on the number of women served by the program.
Developing OrganizationsContra Costa Health Services
Contra Costa County is in California.
Date First Implemented1995
Race and Ethnicity > Black or african american; Gender > Female; Vulnerable Populations > Impoverished; Racial minorities; Women
Problem AddressedDeath rates from breast cancer remain significantly higher among low-income and minority populations than among white women, due primarily to inadequate screening, which leads to late diagnosis and treatment.
- Higher death rates: Although the incidence of breast cancer is about 12 percent lower in African-American women than in White women, African Americans are 36 percent more likely to die from the disease.1 Similarly, although Hispanic women are 40 percent less likely than non-Hispanic White women to be diagnosed with breast cancer, they are 20 percent more likely to die from it.2
- Due to late detection, treatment: These higher death rates appear to be the result of a lack of early detection and treatment. For example, in 1992, only 44 percent of African-American women and 58 percent of Hispanic women with breast cancer in Contra Costa County were diagnosed at an early stage; the comparable figure among white women was 72 percent.3
Description of the Innovative ActivityBetween 1995 and 2002, the Contra Costa Breast Cancer Partnership aimed to reduce disparities in breast cancer–related health outcomes for low-income and minority women, particularly African Americans, by developing culturally appropriate outreach and education designed to reduce the stigma surrounding breast cancer, encourage screening, and secure access to affordable treatment. Key components included forming population-specific task groups, awarding grant funds, sponsoring community-wide programs to promote screening, and coordinating subsidized treatment. Each component is described in more detail below:
- Population-specific task groups: To address the widely held perception that a breast cancer diagnosis was a death sentence, the partnership established community-based task groups to reach out to ethnic communities with culturally appropriate materials and messages, sponsor community events such as health fairs and poetry readings, and work with the local news media, particularly small ethnic papers, to educate the public on issues related to breast cancer. Specific task group activities included the following:
- African-American Task Group: Among the most highlighted of all efforts was the African-American Task Group's production and distribution of a wall calendar featuring local African-American breast cancer survivors as models. Photographed by a prominent Bay Area photographer and reprinted due to its popularity in homes, churches, and businesses in the community, the calendar paired images of strong, confident women with stories of their hopes and dreams for the future. The goal was to promote breast health and encourage breast cancer screening. Members of the African-American Task Group also conducted "woman-to-woman" outreach to residents, beauticians, and church congregants in the community, educating them on the effects of breast cancer within the African-American community.
- Asian/Pacific Islander Task Group: The Asian/Pacific Islander Task Group developed outreach materials tailored to the cultural specifications of this subpopulation. Written in Vietnamese, Lao/Mien, and other languages, the materials also used pictorial representations to encourage annual breast health checkups and screenings. The task force also created culturally appropriate workshop materials and sponsored subsequent workshops for providers.
- Lesbian Task Force: The Lesbian Task Force conducted outreach through a women's softball team, sponsored educational potlucks and house parties throughout the county's lesbian community, and participated in an annual picnic for breast cancer survivors and their families, hosted by the partnership.
- Latina Task Group: The Latina Task Group was the impetus for the development and implementation of the Contra Costa County Patient Navigator Program, which helps non–English-speaking women access and navigate breast health care services. Through this program (which continues today as part of the county health department), Spanish-speaking navigators provide patients with onsite translation services, support and advocacy, and assistance in filling out the complicated paperwork often required to receive care.
- Mini-grants: The partnership distributed four to five mini-grants per year, ranging from $5,000 to $15,000 each, to individuals and community organizations; the grants supported outreach and education efforts aimed at increasing awareness of breast health and promoting early detection and screening.
- Training and education on screening: As a supplement to the activities described above, the partnership developed specific programs designed to encourage screening, including provider training and the promotion of self-examinations by women.
- Provider training: The partnership hosted professional training sessions on issues related to breast cancer screening and cultural awareness. Topics included communicating with patients, documenting and tracking issues, addressing women's emotional concerns and questions, and working with interpreters and patient navigators. Participating providers became a part of the county's network of providers who offer care through California's Breast Cancer Early Detection Program (now referred to as the Cancer Detection Section's Every Woman Counts Program), a program that provides free breast examinations, mammograms, and other diagnostic services to low-income, uninsured, and underinsured women age 40 and over.
- Promoting self-examinations: The partnership worked with a local cable television station to produce an instructional video on breast cancer self-examination. Partnership members wrote the script and starred in the video, which aired numerous times on cable television stations countywide. The video also earned a Telly Award, an honor given to outstanding local, regional, and cable television segments and programs.
- Coordinating affordable treatment: The partnership helped to coordinate treatment for women diagnosed with breast cancer, referring them to one of two participating area medical centers. Treatment costs were subsidized under the California Breast Cancer Treatment Fund, which provided quality breast cancer treatment for a period of up to 18 months to uninsured women 18 years and older with incomes at or below 200 percent of the Federal poverty level.
Context of the InnovationContra Costa Health Services is a comprehensive health system serving the needs of residents of California's Contra Costa County. In 1992, the organization identified breast cancer services for underserved women as a countywide priority, due in part to the county's high incidence of breast cancer (among the highest in the state) and data indicating stark disparities in early detection and mortality rates between African-American and White women. To address these concerns, the health system created the Contra Costa Breast Cancer Partnership, a coalition of more than 400 medical providers, agencies, health advocates, local and state legislators, and breast cancer survivors aimed at reducing breast cancer mortality and improving access to health care for low-income and minority women over age 40.
ResultsPost-implementation data suggest that the partnership enhanced access to breast cancer screening, while pre- and post-implementation data show that it led to earlier detection in African-American and Hispanic women.
Moderate: The evidence consists of pre- and post-implementation comparisons of the percentage of African-American and Hispanic women with breast cancer who were diagnosed at an early stage, and post-implementation data on the number of women served by the program.
- Enhanced access to screening: From 1995 through 2002, the partnership screened roughly 1,000 women for breast cancer each year, most of whom were racial minorities. For example, among the 917 women screened from July 1999 and June 2000, 63 percent were racial minorities. Most of these women would otherwise not have had access to screening.
- Earlier detection among African-American and Hispanic women: County data suggest that 66 percent of African-American women who were diagnosed with breast cancer in 2006 received the diagnosis at an early stage, up from 44 percent in 1992. Likewise, 66 percent of Hispanic women received their diagnosis at an early stage in 2006, up from 57 percent in 1992.
Planning and Development ProcessKey steps in the planning and development process included the following:
- Obtaining initial funding: In 1995, Contra Costa Health Services became one of the first local health departments in the state to participate in the California Department of Health Services' Breast Cancer Early Detection Program, which provided funding to create the partnership.
- Recruiting participants: Contra Costa Health Services used existing networks and community relationships to recruit partnership members, ultimately compiling a mailing list of more than 400 individuals and organizations. Interested parties became members after signing a membership agreement.
- Establishing structure and meeting schedule: A subset of members were elected to comprise a steering committee to provide overall leadership and support, establish priorities, and make recommendations regarding program administration, policy, and services. Partnership members also formed a Community Outreach and Education Committee, an Evaluation Committee, a Continuous Quality Improvement Committee, and four individual task groups targeted at specific underserved communities (as described earlier). The partnership decided to hold quarterly meetings for all members, often featuring topical speakers and presentations.
- Developing training program: After the development of the aforementioned Patient Navigator Program, an intensive training program was created to prepare navigators to work with patients and introduce them to the breast health care system.
- Terminating outreach efforts, institutionalizing core components: In 2002, after having achieved sustained success in encouraging early breast cancer screening in underserved women, the partnership concluded its organized outreach efforts and formally ceased to exist. Several key partnership initiatives, including the Patient Navigator Program, became institutionalized at Contra Costa Health Services and therefore remain in operation today.
Resources Used and Skills Needed
- Staffing: From 1995 through 2002, Contra Costa Breast Cancer Partnership employed four full-time personnel, including a project administrator, clinical services coordinator, health educator, and project assistant, along with a part-time planner evaluator and provider relations consultant. Four Spanish-speaking patient navigators (three full-time, one part-time) currently staff the Patient Navigator Program.
- Costs: The partnership's annual budget between 1995 and 2002 averaged approximately $360,000. The Patient Navigator Program currently operates with an approximate annual budget of $266,000.
Funding SourcesSusan G. Komen Foundation; Avon Foundation; Contra Costa Health Services; California Breast Cancer Early Detection Program; John Muir/Mt. Diablo Community Health Benefit Corporation
Partnership activities were funded primarily through the statewide Breast Cancer Early Detection Program. As noted, navigators were initially funded through partnership stipends; today these individuals are county employees.
Getting Started with This Innovation
- Leverage existing passion for the issue: Breast cancer has directly and indirectly touched the lives of many people. Mobilize community members to participate by calling on their passion for the cause.
- Secure commitment at county level: Ensure that county public health officials understand and are committed to ending breast health disparities among minority communities.
- Get community buy-in: Although community efforts around breast cancer are gaining steam, traditional and high-profile initiatives still often focus on middle class White women. Conduct community outreach to raise awareness of—and build support for ending—racial and ethnic disparities in breast cancer screening and treatment.
Sustaining This Innovation
- Search broadly for funding: Identify potential funders at the state and local level, including both government agencies and private foundations.
- Establish a clear structure: A partnership must have clearly designated leaders to achieve its goals. To that end, ensure that individual and committee roles are well defined, and that the responsibilities of paid staff are well understood.
- Institutionalize successful elements: Institutionalize key program components within a permanent organization, such as the county health department. Integrating these services into routine care helps in securing long-term, consistent funding.
Contact the InnovatorWendel Brunner, MD
Director of Public Health for Contra Costa Health Services
Contra Costa Health Services
597 Center Ave., Suite 200
Martinez, CA 94553
Innovator DisclosuresDr. Brunner has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.
Original publication: March 16, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: February 12, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: February 11, 2014.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.