LONDONDERRY—Dr. Dolores Barbeau stakes out community fairs, exercise classes, churches, senior lunches and shelters, talking exams.
Specifically, breast exams.
“I will go to people’s homes. I don’t care what it takes,” said Barbeau, who recently stood in the doorway to Clark’s IGA in Londonderry to catch people walking past.
In October, Barbeau, a health educator, joined social worker Gloria Dawson to form Neighborhood Connections Center for Health and Social Services, a preventative health care, health education and social service non-profit in Londonderry. Dawson serves as director of the new practice.
The Susan G. Komen for the Cure foundation awarded Neighborhood Connections a $35,000 grant to carry out a breast cancer-screening program to promote early cancer detection and provide education.
The foundation sent out a Windham County-targeted request for proposal after its data showed residents underutilized early detection technologies like mammograms more than other counties.
According to Barbeau, 68 percent of the over-40 population in Windham County is not getting checked for breast cancer.
She said the county is on par with the rest of the state for number of people developing breast cancer and has the lowest number of positive for cancer mammogram results, “which sounds good but more people [above the state average] are dying.”
Barbeau doesn’t know specifically why the low utilization numbers read as they do for Windham County, but she thinks lack of insurance may account for some of the data.
“It’s crazy people are dying of something” they could fight with early detection, she said
The Susan G. Komen for the Cure website advises that “regular screening tests is the best way for women to lower their risk of dying from breast cancer.”
Barbeau has spoken to 400 people so far and conducted 21 exams.
She meets with people twice: once to talk about the program and provide health education and once to conduct the exam.
She also promotes breast exams for men who, although the numbers are lower, can also develop breast cancer. Last year, she says, two men in Windham County were diagnosed.
A screening consists of filling out a detailed health history questionnaire, a clinical breast exam where Barbeau palpates the breast tissue, and a lymph exam.
Afterwards, she sends a copy of the questionnaire and notes to the women’s personal doctors so the exam becomes part of their medical record.
If someone without health insurance participates, after the exam she refers her (or him) to Dawson, who helps find affordable healthcare or connects the patient with a program like Vermont Department of Health’s Ladies First.
Barbeau looks for changes in the skin like dimpling, nipple discharge, unusual masses (lumps), and checks the surrounding lymph nodes.
But, she said, the most important part of the exam is the extensive health questionnaire and the conversation she has with the patient about her individual risk factors.
“I can do the breast exam in 4 minutes. It’s the 10 minutes we spend talking that are important,” she said.
If the exam reveals a sign or symptom requiring further investigation, Barbeau said she follows-up with the patient and her regular physician, or a new physician if Neighborhood Connections also helps the patient find healthcare.
Barbeau has found “something” in three women without insurance and is in the process of following up with one of them.
Agnes Mikijaniec, program manager and oncology nurse practitioner for Brattleboro Memorial Hospital’s Comprehensive Breast Care Program, said BMH’s program started six years ago in a similar fashion as Neighborhood Connections with a grant from the Komen foundation.
At BMH, a nurse navigator helps patients through the process of diagnosis, treatment and follow-up.
The staff helps patients deal with the “social and medical barriers” to treatment she said, like arranging transportation for someone needing to go to Keene, N.H.
A patient may need to see four or five different providers each telling them different information. Or patients may need to travel to Brattleboro or Keene for treatments.
She said the county’s low mammography rates also concern Comprehensive Breast Care Program staff.
Lack of insurance and patients’ own perceived risks are two factors Mikijaniec said she sees that may contribute to the statistics.
Heredity is one risk factor people focus on, but, said Mikijaniec, “it’s closer to the 10 percent portion of the pie.”
Obesity has “strong connections” to breast cancer, and reducing people’s weight reduces their risk, she said.
Risk also increases with age. More than 75 percent of new cases are diagnosed in woman over 50.
According to Ali Johnson, head of the cancer registry for the Vermont Department of Health, despite a negative perception from the 1990s that the state’s cancer numbers were above average, Vermont’s breast cancer statistics are “neck and neck” with national averages. Also, more Vermonters are surviving cancer and living longer.
“But, we can’t fall asleep at the wheel. We can do a lot with early detection,” she said.
For Vermont women, breast cancer is the most commonly diagnosed cancer.
Data from Breast Cancer in Vermont, a 2009 report from the Vermont Department of Health, shows breast cancer accounts for roughly 30 percent of the approximately 1,578 annual cancer diagnoses. Lung cancer, the next most common cancer, accounts for 12 percent of new cancer diagnoses.
About 92 women in Vermont with breast cancer die each year, making it the second leading type of cancer death.
Mary Boyer, who lives in Windham, heard Barbeau speak at a community fundraising organization meeting for the Windham Community Organization.
“She was very informative and committed,” said Boyer, who found the breast cancer statistics for Vermont “startling.”
Boyer persuaded seven classmates, including two men, from her weekly exercise class, ranging in age from mid-50s to 60s, to get examined.
“We’re really committed to our health and well being,” said Boyer, adding Dr. Barbeau’s program fit the philosophy and spirit of their class that began eight years ago as one of Tufts University’s Living Strong programs.
Boyer felt going as a group would remove the reluctance and stigma people have about getting breast exams.
Fellow exerciser Ginny Crittenden said it had been a while since she’d had an exam and was surprised to learn the way doctors recommended palpitating the breasts had changed.
Crittenden said her GP hasn’t always given her a breast exam but after Dr. Barbeau’s program, “I think I’ll be more insistent in the future.”
She was “a little surprised and pleased” two men joined in.
Mary McCoy and husband Michael Simonds each met with Barbeau.
“Any way to catch it early,” said McCoy, who had a cancer scare a few years ago.
It wasn’t cancer, but the experience has made her cautious.
Her sister and close friend recently received breast cancer diagnoses.
And with all the debate in the medical community around who should get mammograms or how to do self-exams “it’s really hard to know what’s the right thing to do,” she said.
Simonds says all the women in McCoy’s exercise class asked their husbands to get screened.
Most declined but he agreed in the hopes of raising awareness and supporting the women.
“It made sense. Breasts are breasts,” he said.
According to a fact sheet prepared by the Komen Foundation, the ratio of female to male breast cancer in the U.S. is 100 to 1. It’s estimated 1,970 U.S. men will be diagnosed this year.
Simonds said Barbeau knows his GP and told him, “[Your doctor] will be very pleased you got this exam.”
“[The program and Dr. Barbeau] was better than expected,” said Boyer, who encourages anyone hesitating about getting a breast exam to call Neighborhood Connections.
In the community
Barbeau said people at the Komen Foundation were excited that she would go into the community and perform the exams.
Komen normally awards grant money to hospitals. The grant’s funding period began in July and runs until March. Barbeau hopes if she gets enough interest the Komen Foundation will extend the grant’s completion date.
Barbeau said women should talk to their doctors about breast health.
The palpitation procedure for clinical breast exams has changed, she said, and some doctors no longer advocate women doing self exams because sometimes they lead to unnecessary tests. Actual risk, versus a patient’s perceived risk, is just one of the topics to discuss with one’s physician.
“There’s a lot of misinformation and fear out there. Fear makes people wait too long,” she said.
Barbeau said she would still be interested in breast health even if she weren’t a breast cancer survivor who needed a bi-lateral mastectomy prior to opening Neighborhood Connections.
Barbeau, Dawson and a largely volunteer staff help connect clients experiencing a crisis with community resources. Dawson also helps people obtain health insurance.
“We wanted to connect the people in the towns around us with the resources that already exist in the town around us,” said Barbeau.
According to Barbeau, Neighborhood Connections works mostly with emergency cases by connecting people to the organizations that can assist long-term. The group operates a revolving loan fund that borrowers can repay over time.
Since October, they have assisted clients who are living in their cars, or who need heating fuel assistance or help getting back on their feet. They serve the communities of Londonderry, South Londonderry, Weston, Chester, Andover, Windham, Winhall, Jamaica, Landgrove and Peru.