CLEVELAND—A 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 men’s 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 Cancer Education.
In 1998, following the Department of Defense’s 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 base’s successful outreach programs for breast cancer screening.
The prostate clinic formed a partnership with the Women’s Wellness Center, a non-hospital-based clinic offering breast cancer screening and gynecologic services. Prostate cancer screening appointments would take place in the women’s center on the day it was normally closed. A prostate cancer support group was planned, and a small library of educational resources was purchased.
Surrogate Motivators
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.”
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 Hunter said that women were identified as potential surrogate motivators in a small, unpublished study of 10 families.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 Women’s 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 it’s necessary to make a decision before randomized clinical trials are done.”
Survey Results
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 men’s 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 men’s 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 women’s 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.”
