African-Americans are leading the fight against breast cancer in
communities across the country. The Witness Project, the East-West
Breast Express, and the Navigator Program are just a few examples of
innovative programs funded by the Susan G. Komen Breast Cancer
Foundation and their local affiliates that are improving the future
for many African-American women.
The Witness Project
In church, people witness to save souls. At the Witness
Project, they witness to save lives, said Mattye J. Willis,
deputy director of the Witness Project, a national program that
enlists African-American breast cancer survivors to share their
stories with other African-American women in their community to
educate them about the disease.
The Witness Project reaches women through their local churches.
This is where women are comfortable talking about themselves.
I am your sister, I am concerned about your health,
said Ms. Willis. Witnesses also reach out to men through the
church. Many women will move faster if the men in their lives are supportive.
Early detection is the witnesses main message. We want to
challenge deeply held cultural beliefs that a woman should not touch
her body or talk about her health, said Ms. Willis. From 6 to 8
weeks after the initial meeting, witnesses (volunteers) follow up
with each woman and help set up mammography appointments. They also
help with any barriers to screening, such as arranging for
transportation and child care.
Established in 1991 by the Arkansas Cancer Research Center in Little
Rock, the Witness Project was initially funded by the Komen
Foundation. In October 1997, the Centers for Disease Control provided
a $1 million, 4-year grant for replicating the program nationwide.
The East-West Breast Express
Go to the people. That is the simple concept behind a
program developed by Selma Morris, MEd, director of the Comprehensive
Breast Center at Emory University School of Medicine and a member of
the African American Womans Initiative (AAWI). The East-West
Breast Express provides breast health education and screenings to
African American women at bus stops, train stations, and other public
The concept for the Breast Express originated in 1994, when a fellow
bus passenger commented on Ms. Morris pink ribbon. When I
explained that the ribbon symbolized breast health, she did not
understand what I was talking about, said Ms. Morris. Over the
next few days, several other people inquired about the pin and the
idea for the program was born.
Community health advocates and volunteers visit train and bus
stations to provide one-on-one education in Atlanta (in
partnership with MARTA [Metropolitan Atlanta Rapid Transit
Authority]) and Oakland, California(in partnership with BART [Bay
Area Rapid Transit]), where the program is coordinated by Bonnie
Wheatley, project director of the Breast Cancer Early Detection
Program in Oakland and an AAWI member.
Individuals take a short survey to determine the level of their
breast health knowledge and receive a bag with educational
information and free gifts (ie, Tropicana coupons, ethnic cookbooks).
Mobile vans are also on site to provide free screenings.
The program, funded by the Komen Foundation, was tested in Atlanta
and Oakland from April to July 1998. Each program reached over 2,000
women and men. Of those eligible, 50% had mammograms. Now, Ms. Morris
is working to expand the program to a national level.
Harlem Hospital Patient Navigator Program
Navigating the health care system can be an insurmountable barrier
for many women when it comes to taking care of themselves, especially
when they no or inadequate insurance. Helping women navigate through
the system, from screening to diagnosis to treatment and beyond, is
the idea behind the Patient Navigator Program at Harlem Hospital in
The Patient Navigator is designed to remove the cultural,
economic, social and medical barriers to quality health care,
said Harold P. Freeman, md, who developed the program in 1990 and is
director of the Department of Surgery at Harlem Hospital Center and
former president of the American Cancer Society.
The idea for the program is based on research showing that poor
people, including the underinsured and uninsured, endure greater pain
and suffering from cancer and face greater obstacles in obtaining and
using health insurance. In addition, the poor often do not seek
needed care if they cannot pay for it, must make extraordinary
personal sacrifices to obtain and pay for health care, and have a
fatalistic attitude that prevents them from gaining quality health care.
The Patient Navigator Program is the nucleus of the Cancer Control
Center, which was established in late 1989 with the mission of
reducing the disproportionately high incidence of and mortality from
cancer in the Harlem community. The navigator is a
proactive patient advocatedistinct from the hospital social
workerwho focuses on the specific needs of cancer patients and
guides those patients through the system.
The role of the patient navigator is to help patients
understand their options. Let us worry about the obstacles,
said Dr. Freeman. For example, the patient navigator can establish
emergency Medicaid coverage for patients, ensuring that they do not
have to wait for or miss diagnostic or treatment procedures.
Patients enter the program through free screening clinics at the
hospital. The clinics are promoted by outreach workers, who spread
the word about the need for early detection at beauty salons, senior
centers, and other community hubs. Patient navigators then identify
patients who need navigation due to abnormal breast
examinations. Through a series of visits and follow-up phone calls,
patient navigators make sure that patients fears about
diagnosis and treatment are allayed and that they do not fall
through the cracks.
Impact of the Program
In 1997, of the more than 2,000 people who were screened through the
Patient Navigator Program, nearly half were uninsured. As proof of
the programs impact on the community, the diagnosis of women
with stage I breast cancer has increased from 1 out of 20 women in
1989, to 4 out of 10 women. The average length of time between
initial breast examination and biopsy for the uninsured decreased to
10 days. In contrast, at most public hospitals across the country,
the length of time can be as long as 60 to 90 days, according to Dr.
The program is funded in part through support from the Komen
Foundation New York Affiliate, New York Race for the Cure.