FIGHT AGAINST CANCER

Program moves
beyond stigma to
save women’s lives

Hawaiians and Filipinos
are targeted for breast and cervical
cancer screening

By Susan Kreifels
Star-Bulletin

Every time Gloria Spallone looks at the "love and kisses" bracelet she's worn every day for the past four years, she remembers her narrow brush with death.

Putting off her regular mammogram for just a few months almost killed her, but doctors caught the breast cancer in time. Her late husband gave Spallone, 52, the bracelet to help her through weeks of radiology that followed her surgery in 1993.

"I always tell women they must go and catch it early," said a tearful Spallone, who works at the Hawaii State Breast and Cervical Cancer Control Program. "Because of their culture, they're so afraid. That is why they don't go for screening. Cancer is a bad word."

Spallone helps drive home the importance of a pilot program that is offering free breast and cervical cancer screening for minority women, mainly 50 and older, who lack insurance and medical services. Officials say the federally funded program, which was kicked off Sept. 2 on Oahu and Kauai, is none too soon in a state that includes some of the highest breast-cancer mortality rates in the country.

The five-year program will target two ethnic groups with disproportionately high mortality rates: native Hawaiians and Filipinos.

The death rate of native Hawaiian women is among the highest of ethnic groups in the United States -- 38 deaths per 100,000 in 1986-1990 compared with a national rate of 22 per 100,000. Provisional numbers for 1991-94 show a slightly lower rate for Hawaiian women at 36.6 deaths per 100,000.

Officials point to a number of possible explanations for the high rates: cultural sensitivity and fear of the tests; no insurance coverage for cancer screening; and a lack of awareness about the importance of early detection. The bottom line: women are not getting the cancer screening that could save their lives.

"Culturally, women find the tests very intrusive," said Lolani Jameson, program coordinator for the Hawaii State Breast and Cervical Cancer Control Program.

"Early diagnosis through screening by mammography, clinical breast examination, and Pap tests remain the most effective ways to decrease morbidity and mortality from breast and cervical cancer."

The program, which Jameson hopes will be operating statewide by April, is using familiar community health organizations to help educate women about the importance of the free screening.

Recent welfare reform is adding urgency. Jameson said that before 1995, about 4 percent of Hawaii's population did not have insurance or qualify for state health programs. With welfare requirements tightened, up to 11 percent of the state's population could be without health coverage. Health officials are unsure how many women will qualify for the free screening, and the University of Hawaii is doing a study to find out how many people are uninsured or underinsured. The screening program is being funded by an $850,000 grant from the Centers for Disease Control and Prevention.

In 1991, the federally funded program started with $40 million. For the coming fiscal year, Congress has approved $140 million to fund similar programs in all 50 states and other U.S. areas including the Northern Mariana Islands, Palau and American Samoa.

An estimated 2 million American women will be diagnosed with breast cancer or cervical cancer in the 1990s, according to Hawaii's Department of Health, and a million of them will lose their lives.

Breast cancer is the most common form of cancer among women in the United States. Early detection through mammograms is the only clinically proven way to prevent deaths.

Rates of cervical cancer have decreased dramatically since the 1970s, believed due to the availability of the Pap test.

Kevin Cassel, community outreach assistant at the Cancer Information Service of Hawaii, said funding the program for five years will encourage behavioral changes in women that will make annual tests a way of life. Participants will be tested annually for five years. The program is starting community advisory groups to find ways to continue the program if funding isn't renewed.