News

Partnership provides cancer treatment for low-income women

By ERICA HALL

Staff writer

Early detection and treatment can increase a woman’s chances of surviving breast cancer, but until recently, that was little comfort for low-income women in King County who didn’t have insurance and couldn’t afford treatment after they were diagnosed.

Katherine Harris of Kent survived breast cancer and is now raising her baby niece, thanks to a state program to provide treatment for women who couldn’t otherwise afford it.

She described how strange it was to be diagnosed with breast cancer almost three years ago. “I’ve always been so healthy,” she said.

Harris always had medical insurance, but when she left her job in September 2001, she couldn’t afford coverage. She didn’t find a new job right away, so she found herself unemployed and uncovered.

In February 2002, she went to a Planned Parenthood clinic near her home for an annual checkup — something she’d done so regularly it was nothing more than routine. She was shocked when the doctor found a cyst on one of her ovaries and said it needed to be removed.

“‘I don’t have insurance. I can’t afford that. Where am I supposed to go?’” she said.

The doctor also asked when she’d had her last mammogram. “‘I don’t know. Probably two years,’” she replied.

A couple weeks later, she went to a clinic and got a mammogram. “They noticed something and said they wanted to do an ultrasound,” she said. “They found a lump in my right breast.”

It happened so quickly. “In February I went in for routine stuff. I end up in April going in for a biopsy, worried about cysts on my ovaries and now here’s this breast problem,” she said.

Harris wasn’t that worried about the lump in her breast. She’d had a cyst in one of her breasts 25 years ago that turned out to be nothing. “I thought it wouldn’t be anything, but meanwhile, I was worried about the cysts on my ovaries,” she said.

But when the biopsy results from the lump in her breast came back, the doctor told her she had cancer. “Now I’m getting brochures and searching on-line,” she said.

Breast cancer is still the leading cause of cancer-related death in women, according to the American Cancer Society’s 2004 cancer facts and figures report, though lung cancer is quickly catching up.

The American Cancer Society estimates 216,000 women and 1,450 men nationwide will be diagnosed with the disease this year. According to the ACS, 40,110 women and 470 men will die from breast cancer this year.

In King County, between 22 and 44 uninsured, low-income women are expected to be diagnosed with the disease each year, according to an epidemiologist at the Seattle-King County Public Health Department women’s health unit.

There are multiple ways women can discover breast abnormalities, including self-checks, clinical visits and mammograms, though mammograms are usually best. “By the time you’ve found something (during a self-check), it’s been there a while,” said Dr. Barbara Levy, a women’s health physician at Fransiscan Health System.

Once a lump is found, doctors image it with mammography and usually take a biopsy to see if it’s cancer. “There are lots of minimally invasive ways to do biopsies,” Levy said, adding, “Not all lumps are cancer.”

If the lump is malignant, doctors can do a lumpectomy, which is usually an outpatient procedure, depending on the location and size of the lump. Additional treatment could include weeks to months of hormone therapy, radiation or chemotherapy.

Prognosis depends on the type of cancer and how aggressive it is, Levy said, but if it’s caught early, the survival rate can be greater than 90 percent.

According to the American Cancer Society, breast cancer mortality rates declined 2.3 percent a year from 1990 to 2000 in all women, most likely because of early detection and better treatment. The five-year survival rate for localized breast cancer has increased from 72 percent in the 1940s to 97 percent today.

After Harris was diagnosed with lobular carcinoma — breast cancer in the lobules, where milk is produced — her concerns about the cyst on her ovary diminished compared to the new threat. Overshadowing it all was the fact she didn’t have health insurance.

“I was thinking, ‘Geez, now what do I do? What can I do?’” she said.

A nurse at Swedish asked her the same question.

“‘I’m not going to do anything,’” she said, informing the nurse she didn’t have enough money for breast cancer treatment.

She said the nurse responded, “‘There’s no way you’re not going to do anything. Don’t let money stand in your way.’”

The Washington Breast and Cervical Health Program was created in 1994 to provide exams for low-income women who didn’t have insurance.

But just providing exams and diagnosis was only solving part of the problem.

“The program was diagnosing cancer in women who weren’t covered by Medicaid and couldn’t afford treatment themselves,” Department of Health spokesman Jim Stevenson said. “It was an awful situation.”

In 2001, the Legislature created a new program that piggybacked onto the screening program. With the promise of a $400,000 grant from the Susan G. Komen Foundation, the new program would allow the state to leverage federal funds to provide cancer treatment for low-income women.

The Komen Foundation’s grant helps pay for some of the costs of the women’s exams as well as the state’s Medicaid match.

There are 173 women receiving treatment through the Komen program. “It’s not a big number, but it’s a significant number,” Stevenson said. “That’s 173 women who didn’t have the resources to pay for their treatment.”

Detection itself isn’t terribly expensive, he said. It’s the treatment that follows: Lumpectomies or mastectomies, chemotherapy and radiation.“Breast cancer is an easy cancer to cure if it’s caught in time,” he said.

The Breast and Cervical Health Program has changed somewhat since its inception, but it’s fairly easy for low-income women to enroll and get screened.

Women can enroll at a participating clinic, said Ellen Phillips-Angeles, manager of the women’s health unit at the county Health Department. And if a woman is diagnosed with cancer, she can be transitioned into the program’s Medicaid treatment program at the clinic level.

In 2002, the year Harris was diagnosed with breast cancer, the program enrolled 2,365 women in King County and re-screened 1,509 former enrollees for breast and cervical cancer. Thirty-four women were diagnosed with breast cancer and eight with cervical cancer.

Community Health Centers of King County screened 269 women in Federal Way, 204 in Auburn, 202 in Kent and 171 in Renton. Highline Community Hospital’s Des Moines Women’s Center screened seven.

Last year, 2,404 King County women were enrolled in the program, and 2,019 enrollees were re-screened. Thirty-eight women were diagnosed with breast cancer and one with cervical cancer.

According to a 2003 report, 92 women in King, Kitsap, Jefferson and Clallam counties, where the program is offered, are receiving cancer treatment. Eighty-four of them have breast cancer, seven have cervical cancer and one has both.

Once Harris was transitioned into the Breast and Cervical Health program’s Medicaid treatment program, she got a CT scan and an MRI.

Technicians found a spot on her liver that turned out to be nothing, but the MRI found another lump in her right breast. That one turned out to be ductal carcinoma — cancer in the lining of the ducts that run through the breast.

She didn’t want to do chemotherapy and radiation. She wanted to believe the breast cancer specialist had conquered the cancer during the lumpectomy.

“I’d heard horror stories about chemo treatment,” she said. “But I thought, ‘I could still have lobular cancer and not know.’”

She decided to do the chemotheraphy and radiation, and she found a doctor who would do the treatments at Valley Medical in Auburn instead of in Seattle. She had a lumpectomy and a hysterectomy — follow-up treatments can sometimes lead to uterine cancer — and then underwent five months of chemotherapy and two months of radiation.

All together, the process took a year, from her diagnosis in Feb. 2002 to her lumpectomies that June, chemotherapy from the end of July to December and radiation in Feb. 2003.

In June 2003, she had another MRI, which she specifically requested after her earlier MRI found a lump the mammogram had missed. It came up clean.

“That was really good news,” she said. “That summer was kind of a long summer for me.”

Sitting in her living room with her niece crawling up to her lap, Harris reflected on how hard that time was and how much help she received.

“Everyone has treated me fabulously,” she said. “The Breast and Cervical Health Program constantly called to check up on me. They sent me stuff in the mail. They were always there to answer questions.”

Staff writer Erica Hall: 925-5565, ehall@fedwaymirror.com

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