Breast cancer remains a considerable foe against a woman’s health next to heart attack and stroke.
According to the non-profit organization
Breastcancer.org, 12 percent of women in the United States will develop breast cancer. That averages to be one out of eight in the population each year.
For women in the U.S., breast cancer death rates are higher than any other cancer, besides lung cancer.
Besides skin cancer, breast cancer is the most commonly diagnosed cancer among American women. More than one in four cancers are breast cancer.
This past April, San Francisco General Hospital was pleased to receive charitable donations from The American Cancer Society, Astra-Zeneca pharmaceuticals and others to launch its Patient Navigator Program to all cancer patients.
This is the 36th Patient Navigator Program site, and the second in California as part of a strategic nationwide effort to significantly extend the reach of this innovative program and assist individual cancer patients in negotiating the health care system.
In 1997 the Patient Navigator Program was initiated with the help of California State Assemblywoman Carol Migden (then a member of the SF Board of Supervisors). The patient outreach program was then designed to meet the needs of women with breast cancer.
While the Patient Navigator program has now expanded to include all patients diagnosed with cancer, the program will continue to meet the needs of women’s health; especially the needs of the uninsured and the under served.
Program coordinator Barbara Cicerelli pointed out that the Breast and Cervical Cancer Services Program at SF General Hospital works in conjunction with the
SF Dept. of Public Health and partners with
University of California at San Francisco Medical Center and many others to help women through a very difficult experience.
Cicerelli and her staff are there to provide the support and guidance needed to take important steps toward health and make crucial decisions in treating the disease.
"We reach out to everyone as San Francisco General Hospital is the safety net for the City," said Cicerelli. We work with the uninsured; many women who do not have access to adequate health care," she said. "Cancer is a scary diagnosis and many women are too afraid to follow up," she said.
The New York Times in 2009 pointed out that the number of women in the American work force has increased significantly to almost 50 percent. And, as this economic recession continues, women are surpassing previous statistics as being the breadwinner for the family.
“Women are much more likely to be in part time jobs without health insurance or unemployment insurance,” said a
report by NY Times journalist Christine Rampell.
This is an indication that women in the role of breadwinner are also the anchor and primary care giver for the family. Having a diagnosis of cancer adds more stress creating more uncertainty.
The Patient Navigator Program seeks to help alleviate some of that stress as Cicerelli explained, “there has been lots of raising of awareness of breast cancer, for testing, screening but follow up has been sparse," she said. This is why follow up through the Patient Navigator Program is so important.
BCCS at SF General Hospital works to coordinate breast and cervical cancer screening services within the San Francisco public health system; and to collaborate with other community partners, such as Lifelines, Breast Cancer Emergency Fund, Charlotte Maxwell Complementary Clinic and American Cancer Society to provide practical and emotional support to women diagnosed with breast cancer.
Avon along with the American Cancer Society has been a major contributor to SF General Hospital’s work in meeting the health care of women in the fight against breast cancer.
In the past five years Avon has contributed over $20 million to SF General Hospital. In 2002 the Avon Comprehensive Breast Care Center was established. Avon also helped support the Patient Navigator Program. “Patient Navigators help patients through the labyrinth of diagnosis and treatment,” said Dr. Marc Hurlbert, PhD executive director of the Avon Foundation.
Since it’s founding over 120 years ago as one of the first multi-level marketing businesses, Avon has always been a champion of women’s needs and their role in society.
While the door-to-door approach has faded away with the changing times, the outreach is the basically the same.
The well-known cosmetics, perfume and gift-accessory network-marketing retailer is best remembered as a door-to-door sales company with the phrase, “Avon calling!”
By the 1950’s with sales over 55 million, Avon was providing high quality products and offering career opportunities to women as sales representatives within their own communities.
In the 1950’s the Avon Foundation was established. Through its foundation, Avon as a company was able to address the needs of women.
“The focus of the foundation then was the importance of education for women,” said Hurlbert. In the early 1990’s the foundation saw breast cancer as an important issue. Patterned after the red ribbon of the AIDS campaign, Avon’s pink-ribbon campaign took off.
“Avon is a company that gives back,” said Hurlbert. The
Avon Walk for Breast Cancer is the Avon Foundation for Women's largest annual fund raising initiative.
The series of nine Avon Walks for Breast Cancer are held each year from April to October in major cities like San Francisco. For the past seven years, Avon Walks have raised more than $350 million and helped raise awareness of the disease.
Many people don’t realize how prevalent breast cancer is and the impact it has. That ratio of one in four averages to 28 percent of the population of women in the USA has breast cancer.
"I lost my mother to breast cancer," said Cicerelli. At that time, Cicerelli was working as a caterer in the restaurant business. "I never thought I would be doing this kind of work," she said.
It was while catering an event that she heard of the Patient Navigator program through the Northern California Cancer Center and later became involved in a breast cancer screening outreach program. Cicerelli then went back to school changed careers and joined the staff.
The primary focus of the Patient Navigator Program is to support patients and help with getting the barriers to access care and treatment minimized. Treatment is complicated and grueling. Patient navigators become the single point of contact in a confusing maze of health services and appointments.
"To have a diagnosis of cancer along with that responsibility of being primary salary earner and provider can be devastating," said Cicerelli. "Some women think that since it is just a small lump, it might just go away," she said.
Or sadly as in some cases, the lack of access to health care, has situations were the cancer has become an enlarged tumor. Dr. Judith Luce, MD is part of the medical team that treats women at SF General Hospital. “Our under served women do not yet enjoy all of these changes and advances in treatment and facilities,” she said.
“Far too often they have never been screened, said Dr. Luce, and because of their fear of the diagnosis, they may seek help very late in their illness.”
Those women who suffer from drug and alcohol abuse are even more vulnerable to falling behind in following up in their health care.
"We have over 350 patients in our program," said Cicerelli. "And our patients may encounter 15-20 different health providers throughout their course of treatment. The patient navigator is the single point of contact ensuring a continuum of care. "We have gotten really good at knowing who to call to help," said Cicerelli.
Yet the level of commitment from the staff in the face of some of the most trying aspects of cancer can be very intimate. With treatments lasting anywhere from three months to over a year, contact with patients can vary. "We provide intensive case management to our patients," said Cicerelli.
"Some patients we contact and visit weekly, others we visit monthly or every six weeks,” she said. “And in some cases we see a patient two or three times a week - providing support each step of the way," said Cicerelli.
"It all depends upon where that patient is in the process," she said. "We meet each patient where they are at not just with the diagnosis or stage of the disease but emotionally," she said.
Cicerelli sees the work she does as a bridge or a lifeline for the most vulnerable. "Getting this kind of diagnosis is overwhelming for many women, especially those who are already burdened," she said.
Support programs like the Patient Navigators helps under served women get access to and participate in the best possible care for their breast cancer. Cicerelli insists that her staff will help find financial assistance.
“Breast cancer changes lives,” said Dr. Luce. And, like many in the medical profession who study this disease, she is puzzled by the complexity of cancer.
“We have also come to realize that all breast cancers are not alike, and our treatment is becoming more tailored to individual patients and their types of tumors.”
Dr. Luce noted that Survivors of cancer are definitely wiser, and tend to appreciate each day and each personal relationship far better than before the disease struck.
Dr. Luce also said that work is often disrupted, especially for women whose jobs do not provide health care or sick time off. “And family lives are disrupted, too,” she said.
The task of helping women sort through the outcomes of their illness is a long term process, and one that the staff and medical team at SF General is often pursuing in order to help them better participate in their care and adhere to treatment.
“Breast cancer is one of the most carefully researched cancers in human beings,” said Dr. Luce.
“While we understand cancer’s variety and complexity far better than we ever have, said Dr. Luce, we haven’t solved the fundamental mystery, the question every woman asks, why did I get cancer?”
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