CLEVELANDA program at Travis Air Force Base in California is
educating men about the purpose of prostate cancer screening by
mailing brochures to the women who use medical services on the base.
This is a novel approach to going after the top mens
cancer, said Maj. (Dr.) Darryl C. Hunter, medical director of
the General Huyser Regional Cancer Center at Travis Air Force Base.
He spoke at the 33rd annual meeting of the American Association for
In 1998, following the Department of Defenses approval of
prostate cancer screening for its enrolled health care beneficiaries,
Dr. Hunter and his team began planning a screening program. Faced
with a limited budget and the recognition that new strategies were
needed to educate men about cancer, the team decided to model the
screening program after the bases successful outreach programs
for breast cancer screening.
The prostate clinic formed a partnership with the Womens
Wellness Center, a non-hospital-based clinic offering breast cancer
screening and gynecologic services. Prostate cancer screening
appointments would take place in the womens center on the day
it was normally closed. A prostate cancer support group was planned,
and a small library of educational resources was purchased.
The clinic decided to target its marketing efforts toward women in
the hope that they would be allies in encouraging men at risk for
prostate cancer to seek screening. Left to their own devices, men are
reluctant to seek out cancer screening, Dr. Hunter said. They need
Surrogate motivators used in other successful education programs have
included church services and sporting events. The Detroit Education
and Early Detection (DEED) initiative presents prostate cancer
information and screening after Sunday church services. Another
effort, described at the American Association for Cancer Education in
1998, uses sporting events to spread information about cancer risk.
Dr. Hunter said that women were identified as potential surrogate
motivators in a small, unpublished study of 10 families. This study
showed that wives were more likely to support prostate cancer
screening and to accept treatment complications than their husbands.
Initially, letters announcing the start of the screening program were
mailed to recent patients at the Womens Wellness Center. Later,
brochures were sent to about 7,000 women age 40 and older who had
recently used the services of the hospital at the base. In addition
to these strategies, press releases announcing the opening of the
prostate cancer screening clinic were sent to local newspapers.
Although the brochure addresses men directly, it appeals to women by
drawing clear parallels between breast and prostate cancer. Both are
common cancers that are highly curable if found early. The brochure
also notes that both cancers are age related. Thus, those at
risk for prostate cancer in many cases are the spouses of those at
risk for breast cancer.
The brochure explains that those at risk include all men over age 50,
black men over age 40, and any man over age 40 with a family history
of prostate cancer. The screening program consists of a
prostate-specific antigen (PSA) blood test followed by a 30-minute
appointment. At their appointment, the men learn their PSA results,
receive a digital rectal exam, and watch a patient education video.
Dr. Hunter said his team realizes that PSA screening is
controversial. However, he added, at Travis Air Force Base, we
believe in PSA screening. Sometimes its necessary to make a
decision before randomized clinical trials are done.
The prostate cancer screening clinic opened in November 1998. In the
first 9 months of the program, 111 men were screened. Eleven were
referred for urologic consult. Two of the 11 were found to have
early-stage prostate cancer and received treatment.
This group of men was surveyed to learn what motivated them to make
an appointment and how they had heard about the program. The
questionnaire showed that the mens wives were clearly the
motivating force, Dr. Hunter said.
Although the men stated in the surveys that they learned about the
program primarily through local newspapers and the brochure, the
wives role in bringing the printed material to the mens
attention may be underestimated, he said.
He knew of several instances in which the wife handed the brochure to
her husband or cut the article out of the newspaper. Spouses
serve not only as important disseminators of health information
within the household but also as advocates in motivating men to
screen, Dr. Hunter said.
The questionnaire also identified gaps in knowledge about prostate
cancer screening. For instance, many men thought they first needed to
have symptoms, such as difficulty urinating, in order to be screened
for prostate cancer.
The informational brochure is now available to everyone using primary
care services on the base. However to reach the 10% to 15% of men
over 40 who are not married, other surrogate motivators may be
needed, Dr. Hunter said.
Utilizing the space and marketing strategies of a womens center
to promote prostate cancer screening is an approach that other
hospitals can imitate. We are utilizing resources available to
many institutions, Dr. Hunter said. This innovative
approach has national applications.