Summer Service Grant | A Community-Based Approach to Breast Cancer Prevention

In summer 2016, Nathaniel Tran (Tufts ’17) explored his interest in public health by researching the barriers preventing women from receiving a basic screening mammogram, particularly in the Boston area. Through Nathaniel’s hard work and many collaborations, the project was able to bring mobile technology to patients, create a sense of community in healthcare, and empower women through health education.


I had just finished speaking with an appointment coordinator at one of the nearby medical centers. She was calling to let me know that a patient had missed her mammography screening appointment, making that the 4th patient to miss so far this week … and it was only Wednesday. What was causing so many women to “no-show” for their mammograms? I work in Boston, Massachusetts, which is home to three academic medical centers, and there is no shortage of medical providers.

ntran-ssg2
Attending and presenting at a health fair at a new potential partner site.

This summer, I made it my goal to better understand the nature of these missed appointments by conducting interviews with community health center patients. Through demographic data, I found that the center serves primarily low-income, underinsured women of color. From the interviews, common themes in our conversations suggested that a combination of a language barrier, poor public transportation, fear of cancer, and loss of potential income prevented these women from following through with their mammography screening appointments.

To address these concerns, I partnered with Dana-Farber’s Mammography Van (DFMV) at the Dana-Farber Cancer Institute to implement the ACE Project. The project has three tenets:

  • Increase accessibility and screening rates by bringing the advanced technology and culturally competent personnel into areas demonstrating the highest need.
  • Encourage women to share resources and information in their own community, allowing friends and family members to benefit from the screening and educational experience.
  • Empower women through education about screening guidelines, breast self-exams, and other women’s health issues.

DFMV is a mobile clinic staffed by certified radiologic technicians and a multilingual breast health educator who provides education to patients. Although the van has been in operation for over a decade, screening rates for several neighborhoods around the city remain low. This project aimed at reaching out to sites across the greater Boston area to develop new community partnerships. To improve accessibility, the ACE Project brings the screening services directly to the suburbs of Boston, helping to eliminate the hour-long commute into the downtown area where the medical centers are located. While on the van, patients also meet with a breast health educator, who reviews cancer risks and ways of conducting a self-screening exam. To provide culturally competent care, these services are offered in multiple languages, and the information level is adjusted for health literacy and education level. DFMV providers speak English, Portuguese, Spanish, Vietnamese, and Haitian-Creole to reflect the ethnic and cultural diversity of the patient population. This combination of approaches helps to provide accessible care to all women in the city with less time spent overall due to a more streamlined registration and screening process.

Everything I’ve told you so far was part of the original ACE Project grant proposal to various funding sources. During this initial phase, I was repeatedly asked “Why would your project succeed over similar endeavors?” and I was able to pull together an answer. Once the project was implemented and I began reaching out to community centers such YMCAs, churches, and recreation centers, I started to fail, the project started to fail. The first Van day scheduled received a total of four phone calls and zero registered patients. Zero. Not a single patient was scheduled, let alone screened. So I took a step back and reached out to the most valuable source of information in this process — the patients themselves. I started asking them where would be the most convenient location for a screening, and after talking to several women for five or ten minutes — some up to thirty minutes — I edited my plans. In all the hype about the project, I had forgotten my guiding principal in the first place: stories matter, voices matter.

ntran-ssg
Facilitating a focus discussion during the Lay Breast Health Advisor training course.

To address the “community” and “education” aspects of the project, the Community Benefits Office developed a Lay Breast Health Adviser (LHA) training program. Women from across the community were invited to participate in a free, one-day course to learn more about basic cancer biology, effective community health advocacy, and communication strategies. Rather than solely relying on physician recommendations, this program prepares the average person with science-based knowledge and effective tools to engage friends and family in conversations about breast cancer and breast health. The informal conversations with trusted social connections helps to destigmatize mammograms, self-screenings, clinical trial participation, health insurance, and many other important aspects to overall health and well-being.

This project was made possible by the generous support from QuestBridge. The project itself so far includes two screening days and one day of LHA training, which has directly impacted over 40 women. The resources and planning that were invested in these events set the foundation for ongoing health advocacy work, with plans to expand screening to new partner sites as a series of LHA training events in additional languages, and with new top sub-specialties including nutrition and diabetes management. What I take away most from this project is that science and clinical medicine alone cannot make systematic change, nor can medical anthropology or public health. It is the intersection of these fields that creates meaningful policy that is pragmatic and also assigns value to each patient within the healthcare system. For me, my experience over the summer has encouraged me to reconsider medicine. I am no longer confident that a career as a physician would bring me the emotional and intellectual fulfillment that I seek. I am now considering graduate programs in combined anthropology and public health for a possible career in qualitative research and health intervention program evaluation.