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Tell-A-Friend Friday:
Making Mammography a Priority

Volume 3, Number 7 - July/August, 1999

Editors: Carol A. Rice, Ph.D., RN, Professor and Extension Health Specialist, and Janet M. Pollard, MPH, Extension Associate-Health

Inside HealthHints....

• Tell-A-Friend Friday: Making Mammography a Priority
• Tell-A-Friend Friday
• Tell-A-Friend Friday: Strategies to Make It Work
• Recruiting Volunteers for Tell-A-Friend Friday
• Be a Team Leader
• What is a Mammogram?
• New Legislation Insures Quality Care
• Health Insurance and Mammography
• About Breast Cancer
• Benign or Malignant?
• Am I at Risk?
• Mammography and Women of Color
• Resources: Black and Hispanic Women and Breast Cancer
• Mammography and Older Women
• Extension Resources
• Other Resources
• Websites with Reliable Information
• References

Tell-A-Friend Friday: Making Mammography a Priority

Breast cancer is the most common type of cancer found in American women, striking 1 in 8 women. However, breast cancer is highly treatable when it is detected early. One of the most reliable methods of detecting breast cancer is mammography screening. - National Breast Cancer Awareness Month (NBCAM) Board, 1999

The American Cancer Society (ACS) would like your help to increase the number of women surviving breast cancer by detecting cancer early with a mammogram.

How can Extension Agents help?

You can help by participating in "Tell-A-Friend Friday," during Breast Health Awareness Month in October. "Tell-A-Friend Friday" involves:

• asking volunteers to call five women aged 40 or older who they care about on Friday, October 1 -- actually any time during October is OK (consider becoming a team leader),
• asking them when they last had a mammogram,
• asking them to make an appointment for a mammogram now if they have not had one during the past 12 months.

"Tell-A-Friend Friday" is important because women listen to their friends and family and because early detection is critical for surviving breast cancer.

This issue will identify the steps for implementing this potentially life-saving program in your county. Information on breast cancer and programming resources are included also.

Tell-A-Friend Friday

Each year, the American Cancer Society (ACS) sponsors an event during Breast Cancer Awareness Month called Tell-A-Friend Friday. On Tell-A-Friend Friday, thousands of women around the country call other women in their communities and encourage them to get mammograms for the early detection of breast cancer.

This year's event will kick-off on Friday, October 1, 1999, and continue every Friday through the end of October.

How It Works

• Each person who participates in Tell-A-Friend Friday is encouraged to call five women they know over age 40 in order to talk with them about mammograms and breast health.
• The caller asks each woman if she has had a mammogram in the past year. If she has not, the caller encourages her to make an appointment.
• The caller then follows up with the woman to see if she has scheduled a mammogram.

How to Get Involved

• Sign up to serve as a caller on Tell-A-Friend Friday -- when you sign up, you'll be given a tracking chart for each woman you call. Consider becoming a team leader.
• Return your chart to ACS -- when you return your chart, ACS will send out a reminder card to every woman who has not had a mammogram in the past year.

Who Can Participate

• Any person with access to a telephone can participate in Tell-A-Friend Friday.
• Both men and women have served as callers in the past. Some are passionate about breast health and some are just concerned about the health of friends. All callers are having an impact on the lives of the women they contact.

Tell-A-Friend Friday is important because women listen to their friends and family. If you would like to participate in Tell-A-Friend Friday, contact the American Cancer Society at 1-800-ACS-2345.

Tell-A-Friend Friday: Strategies to Make It Work

• Order enough "Tell-A-Friend Friday" packets for the number of volunteer callers you think you can recruit in your county; these packets contain everything a caller will need, including answers to frequently asked questions. Call the American Cancer Society (ACS) at 1-800-ACS-2345 to place your order.
• Find someone in your county who will chair this initiative for you or assist you if you want to chair it -- find someone who has been touched by breast cancer and wants to do something about it.
• Work with this person to find others to help recruit callers.
• Contact local health facilities and providers to see if they want to participate.
• Call and find out what approved facilities offer mammograms in your area. Ask if there will be any special mammogram offers during October. (Your local ACS can help you find this information.)
• Contact churches, FCE leaders, other community organizations, your worksite wellness contacts, and local media to find volunteer callers. Ask those interested to call your office to have the packets sent to them.
• Send packets to your volunteer callers.
• When the volunteer has completed her calls, she will send her own materials back to ACS.
• ACS will send you the number of people called in your county and how many women scheduled a mammogram -- this could be important outcome data for monthly reports.

Recruiting Volunteers for Tell-A-Friend Friday

Now that you know about mammograms and their importance, here are some suggestions for recruiting volunteers:

• Advertise your need for volunteers in your local newspaper(s).
• Ask to do a public service announcement on your local radio station(s).
• Suggest Tell-A-Friend Friday as a service project for:
  • Family Community Educators (FCS members)
  • Civic groups such as Rotary, Kiwanis, Junior League, etc.
  • Church groups
  • Senior citizens groups
  • Women's clubs
  • Mother's groups
• Contact the Texas Cancer Data Center (see box above for details) for your county's specific breast cancer statistics, and advertise these to show the importance of mammography in early detection.

Remember, the more volunteers who participate, the greater the impact can be. Tell-A-Friend Friday is an ideal way for you to show impact/outcome data for your specific county regarding mammography and breast cancer.

Be a Team Leader

County Extension Agents can order Tell-A-Friend Friday packets in increments of 10 by becoming a team leader. To be a team leader, you commit to recruiting 10 volunteers who will call five women each about getting their annual mammogram. By requesting to be team leader, the American Cancer Society will send you 10 Tell-A-Friend Friday packets that you can distribute to your participants. You might even see if you can recruit 10 team leaders, instead of just 10 volunteers!

Note: If you choose not to be a team leader, just have each volunteer call ACS to order their individual Tell-A-Friend-Friday packets.

What You'll Find in Your Tell-A-Friend Friday and National Breast Cancer Awareness Month (NBCAM) Promotional Packets

• Tell-A-Friend Friday Calling Kit
  • Five steps to save a friend's life.
  • How to overcome common objections.
  • Tell-A-Friend Friday Tracking Form.
  • Pre-paid return mail envelope to American Cancer Society.
• National Breast Cancer Awareness Month (NBCAM) Packet
  • NBCAM Brochure (English and Spanish)
  • Breast Cancer Fact Sheet
  • Posters and articles on:
    • African American women in the breast cancer movement
    • Early breast cancer detection
    • El Cancer Del Seno Y La Mujer Hispana
    • Get a Mammogram
    • Mammograms...Not just once, but for a lifetime
  • NBCAM logo sheet
  • Early Detection, Diagnosis, and Treatment Flow Chart
  • Board of Sponsors Contact

What is a Mammogram?

This is the routine practice of breast evaluation by "x-ray" in women who have no discernible signs of breast cancer (NBCAM Board, 1999).

When a woman has a mammogram, a specially trained radiologic technologist positions the woman next to the mammography machine. Two flat surfaces compress one breast and then the other for a few seconds. Compression is necessary in order for the technologist to get a clear picture of each breast. Usually two x-rays of each breast are taken, one from the top and one from the side.

Specialists called radiologists, read the mammograms to determine of there is any indication of cancer. Sometimes, they see things that require some follow-up mammograms or other procedures. A call-back for additional examinations does not mean cancer is present -- it does mean that something needs to be looked at further. Remember, 80% of breast tumors are benign.

Besides yearly mammograms, women need to practice monthly breast self-exams and see their doctor or other health professional for a yearly breast exam.

Resource Reminder: Every County Extension Agent should have the Breast Care: The Good News flipchart and Breast Self-Examination Techniques video for use in their educational programs. Copies of the video are also available through the Family Development and Resource Management office. For more information, contact Courtney Schoessow at 979-845-3850.

New Legislation Insures Quality Care

Some women do not have mammograms because they do not want to have to spend time waiting and wondering about the results. The Food and Drug Administration (FDA) now requires that all women be notified in writing of the results of their mammogram within 30 days. If the mammogram is suspicious or suggests cancer, the woman will be notified within 5 days so that she can quickly schedule a follow-up appointment. The FDA also requires that women receive a copy of the mammography report written in lay language. These new regulations also require mammography centers to send original mammograms to the woman or her physician so that they can be compared with earlier ones.

These regulations are part of the Mammography Quality Standards Act of 1992. This Act also ensures that mammography centers in the United States meet certain standards for equipment, image quality, and operator training. The centers must be inspected annually (Harvard Women's Health Watch, 1999). For the location of an accredited center near you, please call 1-800-422-6237.

Health Insurance and Mammography

Health Insurance and Mammography

Call and check with your individual health insurance provider to see if they cover an annual mammogram, and at what age. Check the price before going; specials are often offered during October's National Breast Cancer Awareness Month.

Medicare and Mammography

It is important to note that Medicare covers annual mammograms for women age 65 and over.

Medicaid and Mammography

The following is the age at which Medicaid will reimburse for mammograms:

• Women 35 to 39: Baseline mammogram in conjunction with a professional breast examination.
• Women 40 to 49: Mammogram every two (2) years in conjunction with a professional breast examination.
• Women 50 and over: Mammogram every year in conjunction with a professional breast examination.

Below are some other guidelines for mammographies as well:

• Mammography is payable with an appropriate diagnosis. A mammogram may be medically necessary based on existing signs and symptoms and may be performed without regard to the above schedule when medically indicated. Other breast diagnostic radiology procedures may be medically necessary based upon existing signs and symptoms. When indicated, such procedures are payable.

Mammograms for Women with No Health Coverage of Any Kind

Many facilities offer free or low cost mammography screening to women who qualify. For more information about facilities in your area that offer mammograms at a reduced cost, please call the YWCA at 1-800-95EPLUS (1-800-953-7587) or your local YWCA, or see the BCCCP website at http://www.tdh.state.tx.us/bcccp/.

About Breast Cancer

Cancer is a group of diseases that occur when cells become abnormal and divide without control or order (National Cancer Institute, 1993). Exactly why this happens is not known. However, certain factors such as smoking and age, for example, are known to increase one's risk of cancer.

Benign or Malignant?

When abnormal cells grow rapidly, they form too much tissue. This tissue is called a tumor. Tumors can be benign or malignant.

Of all breast tumors, 80% are benign (NBCAM Board, 1999). Benign tumors are not cancerous. They can usually be removed without growing back. The cells in benign tumors do not invade other tissues or spread to other parts of the body. Benign tumors are not life threatening.

Malignant tumors are cancerous. The cells in a malignant tumor grow and divide uncontrollably, and they invade other tissues and organs. These cells can also break away from the tumor and enter the bloodstream or lymphatic system. This process is how breast cancer spreads and forms new tumors on other parts of the body. This spread of cancer is called metastasis.

Am I at Risk?

A woman's risk of getting breast cancer increases with certain factors. Every woman has some degree of risk for developing breast cancer. However, there are some variables that seem to increase a woman's chances. These factors include:

• Age -- A woman's risk increases as she gets older. Women most at risk for breast cancer are aged 40 or older, but breast cancer can occur at an earlier age.
• Family history -- A woman's risk for breast cancer increases if close female relatives have had breast cancer. Women most at risk for breast cancer have a mother, sister, daughter, or two or more close relatives (like cousins) who have been diagnosed with the disease.
• Personal history -- A woman's risk for breast cancer increases if she has ever had cancer of the breast, ovary, colon, or endometrium (part of the womb). It is also higher if she has ever had a non-cancerous growth on her breast, or if she had her first period before age 12 or had her last period after age 50. A woman is also more at risk if she has never been pregnant or had her first pregnancy after age 30.
• Other factors -- A woman's risk for breast cancer also increases if she is obese; if she eats too many high-fat foods; if she regularly drinks alcoholic beverages; or if she has been on hormone replacement therapy for 5 years or longer (Texas Department of Health, 1997; NBCAM Board, 1999).

Mammography and Women of Color

All women experience a variety of unique, intense, emotional and physical reactions to the diagnosis of breast cancer. Black and Hispanic women come from cultures that are particularly sensitive to the subject of cancer in general. Cancer may be feared in some minority communities because educational opportunities to discuss the prevention, diagnosis, and/or treatment of breast cancer may not exist in places where the majority of these women work and socialize.

Some of the attitudes concerning mammography expressed by Black and Hispanic women range from feelings like "Why tempt fate and make this a reality," or "It's God's will so I am powerless to change what happens." Even though the act of having regular breast examinations, including mammography, aids in the critical factor of an early diagnosis, many of these women have already decided against taking this step.

When working with this population it is important to acknowledge women's fears and concerns as legitimate to their experiences and not minimize the effort it may take to overcome barriers to screening.

When working with women from Black and Hispanic populations, it is important to address the following issues:

• Access to screening may be limited due to lack of transportation, lack of insurance, cost of mammography, service hours, or childcare issues.
  
  Solution: Do the homework in your own county for low cost or no cost services. Find a clinic or other facility that has evening or weekend hours. Look for a mobile unit in your area. Seek organizations that help supplement the cost of an examination.
• There are cultural differences in the reaction to and experience of pain. Many women feel that if there was something seriously wrong with them, like breast cancer, there would be a signal from the body in the form of pain in the breast, headache, backache, etc. If they detected a lump they might expect it to be painful to the touch if is was cancerous.
  
  Solution: Education with this population must focus on the asymptomatic nature of breast cancer and must also help separate fact from fiction with regard to disease detection. Letting women know that some breast pain or tenderness is normal on a monthly basis, while other signs and symptoms may not be normal, is part of this education.
• The "lay referral system" is a major part of the Black and Hispanic culture. Since mistrust of the medical community is an issue, many people believe they can rely on the advice of a friend or relative for health information.
  
  Solution: Instead of attempting to work around this issue, use it to your advantage. There are many materials available to give women the facts about mammography. Enlist the help of support group members from your local community's agencies like the American Cancer Society, to help you get information to the system that these women rely on the most.
• Very few members of the target population are in the audience when breast health information is given out.
  
  Solution: Research based studies and focus groups suggest that to gain a captive audience in the Hispanic community, information needs to be available on morning radio and/or TV programs, as well as morning and evening news. Novella's (i.e., Spanish soap operas) are also a popular medium. Additionally, Hispanic newspapers may be a good solution, but be sure you know when each paper runs to be timely with your articles. Some of these papers only run weekly or monthly.
  
  In the African-American communities it may be helpful to find materials that are designed to be interactive or that reflect a format that is informative but enjoyable, such as a talk show format.
  
  Malls and shopping outlets are also likely places to attract diverse groups with health information. While breast screenings may not be conducive in this environment, blood pressure, or cholesterol checks might be a way to give some immediate health information to a community member, while educating them about other healthy lifestyle issues.

Resources: Black and Hispanic Women and Breast Cancer

Publications

• A Mammogram Saved My Life (pamphlet). Copies are available in English and Spanish from Educational Program Associates, Inc., 1 West Campbell Ave., Ste. 40, Campbell, CA 95008-1039, 408-374-3720. Order #PB2596 (English). Order #PB2597 (Spanish). (Fee).
• Salud: A Latina's Guide to Total Health-Body, Mind and Spirit (book). Copies are available from Harper Collins Publishers, Keystone Industrial Park, Scranton, PA 18512, 1-800-242-7737. (Fee).
• Breast Cancer Bingo. Available by loan through your local American Cancer Society.

Websites

• National Alliance for Hispanic Health (http://www.hispanichealth.org/)
• National Women's Health Resource Center (http://www.healthywomen.org/)

Mammography and Older Women

Many older women have never had a mammogram. Cost, transportation problems, fear, and misinformation keep them from mammograms. Yet, the older the woman is, the greater her risk for breast and other types of cancer.

Here are some common concerns that keep older women from having a mammogram, doing monthly BSE, or seeing her health provider for a yearly breast exam:

• "I have to die of something."
  Yes, we all have to die of something, but you do not have to die from breast cancer. Our family wants you here with us for as long as possible. When breast cancer is found early, it is survivable.
• "I do not want to have a mastectomy so why should I find out if I have breast cancer?"
  When found early, surgery might only involve removal of the lump(s). Yearly mammography can find cancer early.
• "I'm too old to get breast cancer."
  Actually, the older you are, the more of a chance you will develop breast cancer.
• "I've always heard that mammograms cause cancer."
  The amount of radiation you will be exposed to during a mammogram is very insignificant. There is no evidence that mammograms cause cancer. All places offering mammograms are inspected and licensed to make sure all equipment operates properly.
• "I do not want my breasts exposed to anyone."
  Mammograms are done by women technicians who do everything possible to protect your privacy.
• "I do not know where to get a mammogram and I do not have a way to get to a clinic anyway."
  I will find out where you can have one, and I will take you.
• "Mammograms cost too much."
  Medicare pays for a yearly mammogram.

Extension Resources

Videos

• Personal Risks for Cancer (VHS 846, 7:51 minutes, Educational Resource Library -- Addresses the risks of cancer we all face based on age, gender, family history, life practices, and environment.)
• Breast Self-Exam Techniques (VHS, 10 minutes, Educational Resource Library -- Importance of 10 minute self-exam, clinical breast exam, and regular mammography. Shows step by step BSE and important changes to look for.)
• Breast Self Examination: A Special Touch (American Cancer Society) (Code P5, 8 minutes, Educational Resource Library and District Extension Office -- Importance of three exams: self-exam, clinical breast exam, and mammography. Instructions on BSE.)
• Keep in Touch (VHS 1120 or Code P33, 11 minutes, Educational Resource Library -- African-American mother and daughter team discuss unique breast health needs of this target audience. Mammography, clinical breast exam, and BSE discussed and demonstrated.)
• Fibrocystic Breasts: A Non-Disease (Code P167, 8 minutes, Educational Resource Library -- Describes fibrocystic breast changes and the importance of BSE, mammography, and breast health care.)
• Mammography: What Every Woman Should Know (Code P99, 5:45 minutes, Educational Resource Library -- Importance of mammography for breast health. American Cancer Society guidelines.)
• Something Very Special (Code P196, 12:25 minutes, Educational Resource Library -- Designed for use in schools to promote BSE as a lifetime health habit. BSE illustrated by a young girl.)
• Once a Year for Lifetime (VHS, 26 minutes, Educational Resource Library -- Jane Pauly and Phylicia Rashad tell story of five women whose lives are touched in different ways by breast cancer. Purpose to serve as tool to educate women about the need for regular health maintenance, appropriate medical testing, and detection and treatment of breast cancer.)
• Diet and Cancer Prevention (VHS 1195, 15 minutes, Educational Resource Library -- Six guidelines for diet and cancer: healthy weight, reduced fat, increased fruits and vegetables, high fiber, limited alcohol, limited smoked, salt cured and nitrate cured foods. Creating a health menu and how to make changes.
• Una vez al ano...Para toda una vida (Spanish only) (Educational Resource Library -- Video on breast cancer.)

Exhibits/Models

• Breast Cancer (District Extension Office -- Includes breast model. Also bilingual. [1995])
• Multi-type Breast Models, #X-1082 (Educational Resource Library and District Extension Office, 50 counties received their won models at the 1996 Institute in Austin, English and Spanish available. -- An average breast with no lumps, an average breast with lumps, a dense-tissue breast with no lumps, a fibrocystic breast with lumps. All are mounted on a heavy piece of plastic for women to feel the difference in breasts for themselves. [1996])
• Breast Lump Size display (12"x 9"), #X-1084 (Educational Resource Library -- Shows women the difference early detection can make. Makes comparisons in size of breast lumps with ordinary objects (i.e., ping-pong ball, eraser, button, dime, etc.).
• Food Models, #X-1083 (Educational Resource Library -- These models are available for use with cancer and diet programs as well as other nutrition programming for which you may need food models.)

Flipchart

• Breast Self Exam Notebook Flipchart (English and Spanish available) (County Extension Office, distributed during the 1997 update training.)

Other Resources

The following resources are available from the National Cancer Institute. To order call 1-800-4-CANCER.

• Cancer Facts: Screening Mammograms fact sheet
• Cancer Facts: The National Cancer Institute Cancer Centers Program fact sheet on cancer care centers
• Mammograms: Not Just Once But for a Lifetime brochure
• The Facts About Breast Cancer and Mammograms booklet
• Understanding Breast Changes: A Health Guide for All Women booklet
• What You Need to Know About Breast Cancer booklet

Additionally, you can order the following brochure from your local American Cancer Society or by calling 1-800-ACS-2345:

• The Older You Get, The More You Need a Mammogram brochure
• Mammography: Questions and Answers brochure

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References

• American Cancer Society (1999). Tell-A-Friend Friday [promotional packet]. National Breast Cancer Month (1999). Promotion Kit.
• National Cancer Institute (1993). What You Need to Know About Breast Cancer [booklet]. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health. NIH Publication No. 93-1556.
• Texas Department of Health, Public Health Promotion Division, Health Education Risk Reduction (1992). Health Risk Appraisal: Breast Exam. Stock No. 10-15b.

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