Breast Health and Breast Cancer Findings of the Target Communities

Susan G. Komen Minnesotahas chosen five target communities within the service areaas the focus of this Community Profile. When selecting target communities, the Affiliate reviewed Healthy People 2020, a major federal government initiative that provides specific health objectives for communities and the country as a whole. Specific to Komen Minnesota’s work, goals around reducing women’s death rate from breast cancer and reducing the number of breast cancers found at a late-stage were analyzed by Community Health Board area. Through this review, areas of priority were identified based on the time needed to meet Healthy People 2020 targets for breast cancer.

Additional key indicators the Affiliate reviewed when selecting target counties included, but were not limited to:

•Incidence rates and trends

•Death rates and trends

•Late-stage rates and trends

•Screening rates

•Percentage of residents living in a rural area

•Percentage of residents who are American Indian/Alaska Native

•Percentage of female residents who are over 40, over 50, and over 65

The selected target communities were those that were least likely to meet the Healthy People 2020 targets for breast cancer. These communities are:

•Faribault-Martin Community Health Board and Freeborn County area, which encompasses Faribault, Martin, and Freeborn Counties in Minnesota

•Kanabec-Pine Community Health Board area, which encompasses Kanabec and Pine Counties in Minnesota

•Fillmore-Houston Community Health Board area, which encompasses Fillmore and Houston Counties in Minnesota

•Lincoln-Lyon-Murray-Pipestone-Redwood-Rock (SWHHS) Community Health Board area, which encompasses Lincoln, Lyon, Murray, Pipestone, Redwood, and Rock Counties in Minnesota

•Washington County, Minnesota

After selecting the five target communities based on epidemiological data, the Affiliate wanted to learn more about the resources and needs in the five target communities. To do this, the CommunityProfile team conducted telephone interviews with providers across the five areas. Data from these interviews suggests that resources in the five target communities vary. Access to mammography was somewhat limited in several rural communities, including the Faribault-Martin-Freeborn and Kanabec-Pine regions. Treatment services were generally limited in rural communities. For example, the Kanabec-Pine region had only one facility that offers any treatment services. Residents in the four rural target communities, Fillmore-Houston, Faribault-Martin-Freeborn, Kanabec-Pine, and SWHHS, may need to travel outside of their communities for treatment services. Few facilities across all five targeted communities noted that they provide transportation services for screening or treatment. In general, support services were also somewhat limited, especially in the rural areas. The Affiliatealso found that many providers in the target areas provide women with breast self-exam training, rather than the more comprehensive evidence-based approach that Susan G. Komen recommends. This approach includes knowing one’s risk, getting screened, knowing what is normal for the individual, and making healthy lifestyle choices.

Susan G. Komen Minnesota has long-standing collaborative relationships with several key statewide partners, including the American Cancer Society, the Minnesota Cancer Alliance, and the Minnesota Department of Health’s Sage Screening Program. The Affiliate partners with these agencies in public policy initiatives, and plans to continue to strengthen these partnerships throughout the next four years.

The Community Profile team conducted key informant interviews with clinicians, public health officials, advocates, and survivors in the five target communities to learn more about the barriers and challenges women may face in accessing care across the continuum. Several needs and resources identified in the key informant interviews were common across the five target communities. Each community also had its own unique strengths and challenges related to breast health.

  • In general, most key informants from the five target communities noted that awareness of breast health was high in their communities.
  • Transportation was noted as a barrier to screening, diagnosis, and treatment services in the four rural target communities, which includes the Faribault-Martin-Freeborn, Fillmore-Houston, Kanabec-Pine, and SWHHS Community Health Board areas.
  • Access to treatment and specialty care was also noted as a challenge in the four rural target communities, which includes the Faribault-Martin-Freeborn, Fillmore-Houston, Kanabec-Pine, and SWHHS Community Health Board areas.
  • Key informants in Kanabec-Pine, Washington County, and SWHHS Community Health Board area noted the need for improved patient navigation services in their communities.
  • Each community identified subpopulations that may be less likely to receive screening services. In addition, according to Minnesota Community Measurement (2015), the breast cancer screening rate is lower for women in Minnesota with publically-funded health insurance than for women with privately-funded health insurance.
  • Communities with greater ethnic diversity noted that women of some racial/ethnic identities (for example, American Indian women) may be less likely to receive screening than White women.
  • Several communities identified poverty and being uninsured or underinsured as barriers to screening, diagnosis, and treatment.
  • Two communities are home to populations of women who may not receive screenings due to religious preferences.
  • Most of the target communities noted a preference for personalized outreach, such as in-person contact at health fairs and community events.

The Affiliate also reviewed published documents about breast health in Minnesota. These documents noted that low-income women may face additional barriers in accessing the continuum of care. In addition, according to data analyzed by Minnesota Community Measurement, Minnesota women enrolled in publically-funded health insurance programs complete breast cancer screening at a lower rate than women enrolled in privately-funded health insurance programs.

Mission Action Plan

Susan G. Komen® Minnesota will work collaboratively with the Board of Directors, Board committees, staff of the Affiliate, and other key stakeholders to execute a Mission Action Plan which captures the priorities of all stakeholders. Based on the findings of this Community Profile, the Affiliate will work with partners and stakeholders to execute a plan which will aid them in developing or supporting population appropriate breast health programs to close gaps and address deficiencies as outlined in the report. It should be noted that the Affiliate will continue to support communities throughout Minnesota, in addition to those prioritized in this report. Key needs in the target communities, and the Affiliate’s priorities and objectives related to these needs are described below:

Need Statement 1: There is variability in breast cancer screening rates among subpopulations of women in Minnesota.Data from Minnesota Community Measurementindicates that women enrolled in publically funded insurance programs are less likely to be screened for breast cancer than women enrolled in privately funded insurance programs. Furthermore, key informants in each of the five target communities noted specific subpopulations in their communities they thought were less likely to be screened than others, including low-income women, American Indian women, Somali women, and others. However, quantitative data on screening rates of subpopulations of women within the target communities was not available for the Community Profile report. The Affiliate has developed the following priorities and objectives in response to this need:

Priority area 1: Identify subgroups of women within each of the five target areas with lowerscreening rates. Explore potential explanatory factors for these differences.The Affiliate developed this priority in order to learn more about which specific subgroups of women are less likely to be screened, and to identify reasons for these disparities. Knowing this information will allow the Affiliate to efficiently target resources to reduce screening disparities. The Affiliate has the following objectives related to this priority:

Objective I: By fiscal year 2017, the Affiliate will examine Minnesota Community Measurement data to learn more about disparities in screening rates in each of the five target communities. Minnesota Community Measurement data includes screening rates for medical centers and clinics of large health systems throughout the state. Examining this data will be useful to the Affiliate in identifying subpopulations with lower screening rates in target communities and potentially providing clues for why the rates are lower.

Objective II: By fiscal year 2017, disseminate findings from the exploration of Minnesota Community Measurement data. This may include disseminating findings to health systems, local providers in the five target communities, and others to educate stakeholders about variability in breast cancer screening rates.

Priority area 2: Develop and implement strategies to improve screening rates in the identified subgroups in each of the five target communities. The Affiliate developed this priority in order to create an action plan that responds to what is learned from the Minnesota Community Measurement data. The Affiliate has the following objectives related to this priority:

Objective I: By fiscal year 2018, create an action plan to improve screening rates among subpopulations of women in each of the five target communities who are less likely to be screened, based on the findings from Minnesota Community Measurement data and other relevant information (e.g., research evidence for what works to increase screening rates).

Objective II:By fiscal year 2019, carry out the action plan that will be developed in fiscal year 2018. This may include collaborating with local stakeholders and partners, such as the American Cancer Society, Minnesota Department of Health, and local partners in each of the five target communities.

Need Statement 2: Navigating the breast health system of care can be difficult for women in the Kanabec-Pine, Washington County, and SWHHS Community Health Board areas.Key informants in these target areas noted that it may be difficult for women in their communities to navigate the system of care, and noted a need for improved patient navigation. The Affiliate has developed the following priorities and objectives related to this need:

Priority area 1: Identify challenges in the Kanabec-Pine, Washington County, and SWHHS areas that make it difficult for women to navigate the system of care. While each of these three target areas noted challenges with patient navigation, the Affiliate developed this priority to learn more about the specific challenges in each area. For example, there may be challenges with navigation during any stage on the breast health continuum of care, including screening, diagnosis, treatment, and follow-up care. Further identifying specific challenges in each target community will allow the Affiliate to align resources with the most pressing needs in each community. The Affiliate has the following objectives related to this priority:

Objective I: By Fiscal Year 2017, the Affiliate will share findings from the Community Profile with at least two providers in each of the three target areas of Kanabec-Pine, Washington and SWHHS Counties in order to raise awareness of the need for patient navigation services in their communities.

Objective II: By Fiscal Year 2018, the Affiliate will partner with health systems in each of the three target areas of Kanabec-Pine, Washington and SWHHS Counties to identify specific navigation challenges for their patient populations.

Priority area 2: Increasepatient navigation services in the Kanabec-Pine, Washington County, and SWHHS areas. The Affiliate chose this priority because patient navigation can support patient care at all stages of the breast health continuum, improve the patient experience, and reduce barriers to care. The Affiliate has developed the following objectives related to this priority:

Objective I: By Fiscal Year 2017, the Affiliate will identify at least one partner in each of the three target communities of Kanabec-Pine, Washington and SWHHS Counties who have an interest in improving patient navigation services. These partners will be encouraged to apply for grant funding to improve their patient navigation services.

Objective II: By Fiscal Year 2018, the Affiliate intends to fund partners through its community grants program to improve patient navigation services in Kanabec-Pine, Washington and SWHHS Counties.

Need Statement 3: There is a need for a more comprehensive, evidence-based approach to breast health education at some sites within each of the five target communities. Based on Susan G. Komen recommendations, this approach would include knowing one’s risk, getting screened, knowing what is normal for the individual, and making healthy lifestyle choices. In order to increase the use of these best practices for breast health education, the Affiliate has chosen the following priorities and objectives related to this need:

Priority area 1: Identify which hospitals, clinics, community and/or nonprofit organizations in each of the five target communities could benefit from a more comprehensive, evidence-based approach to breast health education.The Affiliate is aware of the breast health education practices of each of the clinics that completed the provider survey, but needs to learn more about the sites that did not complete provider surveys. The Affiliate has the following objective related to this priority:

Objective I: By Fiscal Year 2017, the Affiliate will reach out to the siteswithin each of the five target communities that did not complete the provider survey to learn about their current breast health education practices.

Priority area 2: Increase the use of evidence-based breast health education in each of the five target communities. The Affiliate chose this priority so that more women in the target communities would have access to breast health education that aligns with the most recent best-practices recommendations. The Affiliate has the following objectives related to this priority:

Objective I: By Fiscal year 2017, the Affiliate will partner with two hospitals, clinics, community and/or nonprofit organizations in each of the five target communities and provide resources and training on the most current Susan G. Komen breast health education model.

Objective II: By Fiscal Year 2018, the Affiliate will partner with at least two clinics in each of the five target communities to update their practices around comprehensive breast health education.

Susan G. Komen® Minnesota