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1. Increase in the # of mammograms performed for Black women in California in 3 years.

2. Decrease the # of Black women who are diagnosed at an advanced stage of breast cancer in California over the span of 3 years.

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Second Leading Cause of Death Among Women

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Second Leading Cause of Death Among Women

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According to American Cancer Society (2023), breast cancer is the second leading cause of death among women. A woman in the United States has a 13% chance or 1 in 8 probability of developing breast cancer at some point in their life.

(Breast Cancer Statistics | How Common Is Breast Cancer? (n.d.). https://www.cancer.org/cancer/types/breast-cancer/about/how-common-is-breast-cancer. )

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Breast cancer is a disease in which harmful cells in the breast grow out of control. There are numerous types of breast cancer, but they each depend on the types of cells that become cancerous. It can occur in men, although it is most commonly seen among women. As with all cancers, early detection with the help of regular screening is essential for prevention and timely treatment, if needed. Breast cancer that goes undetected can continue to grow in the breast tissue and eventually metastasize, i.e. spread to other parts of the body.

(Centers for Disease Control and Prevention. (2023, July 25). Basic Information About Breast Cancer. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/breast/basic_info/index.htm)

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Black Women are More Likely to be Diagnosed at an Advanced Stage of Breast Cancer

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Black Women are More Likely to be Diagnosed at an Advanced Stage of Breast Cancer

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Among the Black women who are diagnosed with breast cancer, they often present a late stage of breast cancer at diagnosis compared to other racial and ethnic groups. Late stage cancer often results in a lower survival rate and more aggressive treatments.

(Yedjou, et. al. (2019). Health and Racial Disparity in Breast Cancer. Advances in Experimental Medicine and Biology, 1152(1152), 31–49. https://doi.org/10.1007/978-3-030-20301-6_3)
(Wang et. al.(2010). Healthcare access, socioeconomic factors and late-stage cancer diagnosis: an exploratory spatial analysis and public policy implication. International Journal of Public Policy, 5(2/3), 237. https://doi.org/10.1504/ijpp.2010.030606)

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Black Women Experience Various Barriers in  Mammography Screening

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Black Women Experience Various Barriers in  Mammography Screening

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Researchers Mollie Aleshire et al. conducted a study in 2020 that aimed to explore potential barriers that Black women face in terms of access to mammograms. Their analysis of the results identified multiple barriers to mammography: accessibility, affordability, availability, accommodation, and acceptability.

Based on these results, Black women are in need of interventions that can dismantle the structural barriers they experience.
(Aleshire, M. E., et al. (2021). Access to Care as a Barrier to Mammography for Black Women. Policy, politics & nursing practice, 22(1), 28–40. https://doi.org/10.1177/1527154420965537)

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Suboptimal Utilization of Annual Screening Mammograms

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Suboptimal Utilization of Annual Screening Mammograms

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In a recent study of the frequency of mammography screening, researchers found that Black women presented low screening rates for breast cancer. Participants of this survey also reported many barriers to this service, including fearful sentiments, lack of insurance coverage, and more.

(Jones et. al. (2023). Barriers to Mammography Screening among Black Women at a Community Health Center in South Florida, USA. Medical Research Archives, 11(4). https://doi.org/10.18103/mra.v11i4.3814)

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1. Increase the # of Black women in CA who seek medical care related to screening over the course of 1 year. (Behavior)

2. Increase in the # of individual breast examinations performed at home by Black women in California over a 12 month survey period. (Behavior)

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Age Distributions of Breast Cancer Diagnosis and Mortality by Race and Ethnicity in US Women 

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Age Distributions of Breast Cancer Diagnosis and Mortality by Race and Ethnicity in US Women 

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Among women dying of breast cancer, non-Hispanic Black women have a 111% higher risk than non-Hispanic White women.

(Hendrick, Monticciolo, et. al. (2021). Age distributions of breast cancer diagnosis and mortality by race and ethnicity in US women. Cancer, 127(23), 4384–4392. https://doi.org/10.1002/cncr.33846)

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1. Increase in the # of Black women in California who believe that breast cancer screening is important for early diagnosis by 6 months. (Attitude)

2. Increase in the # of Black women in California who are aware that they are at a heightened risk for developing breast cancer by 6 months. (Knowledge)

3. Increase in the # of Black women in California who know how to recognize signs and symptoms of breast cancer by 6 months. (Knowledge)

4. Increase the number of Black women in California who believe that self-assessment is important in order to know when to seek care over a 6 month timeline. (Attitude)

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A Personal Story of Systemic Barriers Faced by a Black Woman

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A Personal Story of Systemic Barriers Faced by a Black Woman

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Jessica Florence discovered a tumor on her right breast while in college. The 21-year-old did not believe what she discovered was serious until she began to experience pain and other symptoms.

"When I think of breast cancer, I think of, you know, an older woman ― 40 or 60 ― but not 21 or 22," says Jessica. Jessica, who leads a healthy lifestyle and has no family history of breast cancer, discussed her worries with her primary care practitioner. "My gynecologist told me that it could not be breast cancer because I was too young to have breast cancer," says Jessica. Her instincts, on the other hand, drove her to seek a second opinion. Jessica was diagnosed with stage 3 breast cancer by the time anyone noticed.

"African American women are twice as likely to be diagnosed with breast cancer earlier when compared to Caucasian women, and unfortunately, they have three times the mortality rate," says Sabrina Sahni, M.D., an oncologist and breast specialist at the Jacoby Center for Breast Health at Mayo Clinic in Florida.

To this day, Jessica is still undergoing chemotherapy and radiation. Stories like hers really showcase the importance of eliminating the stigma and systemic barriers that prevent Black women from receiving adequate healthcare.

Osiadacz, A. (2021, October 13). A third chance for a young breast cancer patient. Mayo Clinic News Network. https://newsnetwork.mayoclinic.org/discussion/a-third-chance-for-a-young-breast-cancer-patient/

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Breast cancer does not discriminate ― a truth that a young Florida woman knows three times over. While in college, Jessica Florence found a lump on her right breast. The 21-year-old initially did not believe what she found was serious until she was in pain and experiencing other symptoms.

Watch: A third chance for a young breast cancer patient.
Journalists: Broadcast-quality video (2:00) is in the downloads at the end of this post. Please courtesy "Mayo Clinic News Network." Read the script.
"When I think of breast cancer, I think of, you know, an older woman ― 40 or 60 ― but not 21 or 22," says Jessica.

With a healthy lifestyle and no family history of breast cancer, Jessica brought her concerns to her primary care provider.

"My gynecologist told me that it could not be breast cancer because I was too young to have breast cancer," says Jessica.

Her instincts, however, led her to seek a second opinion. By the time someone paid attention, Jessica was diagnosed with stage 3 breast cancer.

"African American women are twice as likely to be diagnosed with breast cancer earlier when compared to Caucasian women, and unfortunately, they have three times the mortality rate," says Sabrina Sahni, M.D., an oncologist and breast specialist at the Jacoby Center for Breast Health at Mayo Clinic in Florida.

After surgery, radiation and chemotherapy, Jessica was looking forward to renewed health. But months later, Jessica's cancer was back, and this time it had spread to her spine. Knowing she needed other options, Jessica turned to Mayo Clinic.

"I will say Mayo Clinic has been the best thing that has ever happened to me," says Jessica.

Dr. Sahni explains younger women may not consider themselves to be at high risk, but the reality is breast cancers are diagnosed at all ages.

"Women across the board, regardless of ethnicity, should really be counseled to check their breasts," says Dr. Sahni.

Jessica recognizes her chance to change the stigma around cancer and has chronicled her journey on social media.

"There are a lot of African American women who go through breast cancer who don't tell their story," says Jessica. "So I kind of made my social media my diary, and I know it helped a lot of women."

Jessica's story is a reminder to all women to be vigilant when it comes to changes in their bodies.

"If they feel something, they should really say something about it, and they should not feel, you know, like, I'm too young," says Dr. Sahni.

Jessica continues to receive chemotherapy between architecture classes, which she is attending remotely. Her strength and spirit are on display at every appointment, right down to her bright pink running shoes.

"Tomorrow is not promised to any of us," says Jessica. "So a year from now, I see myself successful ― being that successful architect that I want to be because Mayo Clinic gave me that quality of life," says Jessica.
________________________________________ For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.
Related articles

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A third chance for a young breast cancer patient - Mayo Clinic News Network

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Breast cancer does not discriminate ― a truth that a young Florida woman knows three times over. While in college, [...]

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Cancer represents a significant portion of total U.S. health care spending.

Approximately $183 billion was spent in the U.S. on cancer-related health care in 2015, and this amount is projected to grow to $246 billion by 2030 - an increase of 34%.

The average total cost of per-patient breast cancer treatment ranges from $60,000 to as much as $135,000 depending on your diagnosis.

For more information on the costs of cancer you can visit: https://www.fightcancer.org/sites/default/files/National%20Documents/Costs-of-Cancer-2020-10222020.pdf.

(American Cancer Society Cancer Action network. (2020, October). The Costs of Cancer. https://www.fightcancer.org/sites/default/files/Costs%20of%20Cancer%20-%20Final%20Web.pdf)
(Blumen, H., Fitch, K., & Polkus, V. (2016, February). Comparison of treatment costs for breast cancer, by tumor stage and type of service. American health & drug benefits. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822976/)

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Common Health Coverage Issues that Add to Patient Out-of-Pocket

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Common Health Coverage Issues that Add to Patient Out-of-Pocket

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Here is a list of common health coverage issues that add to patient out-of-pocket and lead to increased financial burden for patients that sometimes result in the forgoing of treatment.

Costs for non-covered services do not count toward a patient's out-of-pocket maximum, so patient costs for non-covered treatments are unlimited and can add up quickly.

High deductible plans require patient to pay full price for all tests out-of-pocket until the deductible is met.

Cancer patients often have trouble finding out what the total cost for treatment will be ahead of time, and therefore cannot predict the amount of co-insurance they will owe.

Surprise medical bills occur when an insured patient is unknowingly treated by an out-of-network provider and is then billed the difference between what the provider charger and what the insurer paid.

Unexpected costs for preventive/screening services due to loopholes that can qualify a routine screening as a diagnostic procedure and change the charges to be that of a diagnostic procedure.

(American Cancer Society Cancer Action network. (2020, October). The Costs of Cancer. https://www.fightcancer.org/sites/default/files/Costs%20of%20Cancer%20-%20Final%20Web.pdf)

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Breast Cancer is Treatable When Caught Early!

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Breast Cancer is Treatable When Caught Early!

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When breast cancer id detected early in stage 0 or stage 1, breast cancer is very treatable and survivable.

5-year relative survival for women diagnosed with breast cancer that had not spread beyond the breast was 99%.

With recent improvements in treatment, survival for women diagnosed today may be even higher.

It is important to be diagnosed early to be able to avoid chemotherapy which is both costly and very difficult on the individual's body.

(Survival for breast cancer. Cancer Research UK. (2023, June 8). https://www.cancerresearchuk.org/about-cancer/breast-cancer/survival)
(Treatment of early breast cancer. Susan G. Komen®. (2023, September 22). https://www.komen.org/breast-cancer/treatment/by-diagnosis/early-stage/ )

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Pledge For Pink (PFP)

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Black women of all ages residing in 4 major cities in California (Vallejo, Sacramento, Oakland, & Antioch) with the highest prevalence of late stage diagnosed breast cancer in Black American women.

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Program Activities Phase 1: Program Development (1-3 months)

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Program Activities Phase 1: Program Development (1-3 months)

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Hire staff

Identify spaces throughout our target California cities to rent for program activities

Create and develop social media outlets

Develop curriculum to train ThinkPINK Ambassadors about breast cancer (what it is, the risks, how it can be prevented and treated), social marketing, and public speaking

Develop educational workshop to educate Black women in California about their risks for breast cancer as well as prevention methods

Establish community partnership

Recruit 15 Black individuals from California to be ThinkPINK Ambassadors

Recruit 10 Black individuals who are survivors of breast cancer to share their stories

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Program Activities Phase 2: Program Implementation (4-21 months)

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Program Activities Phase 2: Program Implementation (4-21 months)

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Train Pledge For Pink Ambassadors

15 Pledge for Pink Ambassadors meet for 4 hours for 3 days a week for 2 weeks for training and to design ThinkPINK outreach materials and messages for social media campaign

Pledge For Pink Ambassadors Conduct ThinkPINK Training

Pledge for Pink Ambassadors distribute information sheets and conduct street outreach to Black women in 4 major cities in California to encourage them to attend the ThinkPINK training.

Pledge for Pink Ambassadors conduct a 1.5 hour ThinkPINK educational meeting once a month on Saturdays (afternoon) and Sundays (morning) across 4 major cities within 4 California counties for 17 months

Training Approach

Observation

Interactive lectures

Creating a plan

Conduct Social Media Campaign

Promote awareness about breast cancer, and how to detect early signs through flyers, posters, and social media posts using our campaign messages.

"ThinkPINK" social marketing campaign runs for 10 months

Pledge for Pink Ambassadors engage in media advocacy by obtaining interviews in with television and print local news, and sharing short informational videos on our website and social media pages.

Share information about local breast cancer screening clinics, support groups, and other services

Share personal stories for others to see and hear

By using social media campaign as a tool it will help our program to reach and connect easily to convey our message within larger communities for African American women

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Program Activities Phase 3: Closing (22-24 months)

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Program Activities Phase 3: Closing (22-24 months)

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Host "Pink" parties with participants and Ambassadors to highlight and celebrate increased awareness about breast cancer and reduced late-stage diagnoses among the 4 major California cities

Gather videos and photos of our events and upload them to our social media page and our website to acknowledge our efforts and accomplishments

Conduct evaluation activities

Develop a final report of the Pledge for Pink program

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15 Pledge for Pink Ambassadors

1 curriculum to train Pledge for Pink Ambassadors

1 ThinkPINK training curriculum for program participants

510 Black individuals (15 people per training) educated in ThinkPINK

8 interviews of Pledge for Pink Ambassadors on local news outlets

250 social media posts as part of the ThinkPINK campaign

80 posters and flyers distributed in 4 major California cities as part of the ThinkPINK campaign

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(see attached for more information)