Mammography Van Brings Breast Cancer Screening to the Workplace

In the heart of the Bible Belt, a North Carolina-based companyis spreading the gospel that women need to know their bodies,regularly examine their breasts, and receive mammograms yearlyafter age 40.

Metrolina Outreach Mammography, the brainchild of Jean Griswold,a 48-year-old businesswoman, preaches this message mostly at textilemills in the South, but also at shopping malls, bowling alleys,churches, geriatric centers--wherever women can be found.

"Many of the women we see don't have much formal education.They don't understand they can save their own lives," Ms.Griswold says. Her ideas have met with some resistance. Afterviewing a video on breast self-examination (BSE), one woman calledit "pornographic."

Ms. Griswold calls this attitude a "cultural bias [that suggests]it's a sin to touch yourself. But we have a high compliance rateif we can conduct our educational program. It takes the fear away,and allays superstitions about the danger of x- rays and compression,which some women believe will make a tumor spread."

Metrolina staffers spend half an hour with workers in a plant,for example, teaching them about breast cancer, BSE, and the importanceof regular clinical breast exams and mammograms. They distributebrochures and water-proof BSE instructions to hang in the shower.

Then women can schedule a 20-minute visit to the specially equippedvan, which contains a wheelchair lift and changing rooms. Thefilms are read by certified radiologists who relay the resultsto the patient's family doctor.

Among working women, one of the most oft-cited reasons for notgetting a yearly mammogram is lack of time. With the mammogramvan at the job site, sometimes operating around the clock to accommodate"graveyard shift" workers, "we take away the biggestreason for procrastination," says Ms. Griswold, who willbe one of the speakers at this year's annual conference of Industries'Coalition Against Cancer (ICAC) . At the Fort Lauderdale meeting,being held March 30 to April 1, she will discuss her experiencesat Metrolina, highlighting the how-to and cost of institutinga mobile van breast cancer screening program.

Home Innovations, a textile mill in Mooresville, North Carolina,where women comprise 80% of the work force, is typical of thesites Metrolina visits. Many of the women who step into the mobileunit have never had a mam-mogram or practiced BSE.

Nancy Barnette, payroll manager for Home Innovations, signed upfor her first breast x-ray when she was 51 years old. She wasshocked to learn that she had a malignancy.

"The plant management strongly urged us to go to the trainingsession and make a mammogram appointment. Since the van was righthere and was so convenient it made all the difference in the world,"Ms. Barnette says. "Now I know it was the most importantthing I could have done." After a mastectomy and 15 chemotherapytreatments, she reports she is "doing fine."

According to Home Innovations benefits manager Karen Stamey, theMetrolina program has been "a huge success." In 1993,she says, "the company spent $22,000 on screening. But thatis nothing compared to the amount we would have had to spend ona worker with cancer found in a late stage. With Nancy, her tumorwas caught early enough for her to recover and come back to work.So the company has taken a step to save money by spending money."

'The Most Cost-Effective Method'

A direct drop to the bottom line may glimmer off in the distancesome 6 to 12 months hence, Ms. Griswold says. But the cost ofearly detection averages $12,000, while the cost of late-stagedetection can rise to $140,000 or more per patient.

According to Nanette DeBruhl, MD, assistant professor of radiologyat the University of California in Los Angeles, mobile mammographyis "the most cost-effective method for breast cancer screeningin the new health-care environment." Dr. DeBruhl and hercolleagues conducted a national survey of 129 mobile programscurrently operating in the United States.

Metrolina foots the bill for the educational component, Ms. Griswoldsays. She plows back into the program funds received from theCenters for Disease Control and Prevention, county health departments,Medicaid, and Medicare. In some companies, such as Home Innovations,employers pay the total cost of the mammogram.

Ms. Griswold hopes to expand her reach into more rural areas toserve indigent and elderly populations. She is fueled by zealand even anger.

"If we can convince women to take an active role in breastcancer screening, we can save their breasts and save their lives,"she says. "I've seen too many of my own friends who havehad mutilating surgery or who died from the disease, includinga 48-year-old nurse who should have known better. It makes meangry that we, who are the caretakers, can't take better careof ourselves. The only thing we have going for us now is educationand early detection until we can find the causes of breast cancerand eradicate it."