SOON AFTER MARIO SCHOOTMAN, PHD, AN EPIDEMIOLOGIST, CAME TO WASHINGTON UNIVERSITY IN 1999, HE REVIEWED DATA FROM THE MISSOURI CANCER REGISTRY AND NOTICED A DISTURBING TREND AMONG PATIENTS WITH BREAST CANCER: FROM 1996 TO 1998, WOMEN WHO WERE 50 AND OLDER WERE TWICE AS LIKELY TO HAVE LATE-STAGE BREAST CANCER IF THEY LIVED IN CERTAIN ZIP CODES IN THE NORTHEASTERN PART OF ST. LOUIS. SCHOOTMAN, WHO IS CO-LEADER OF THE PREVENTION AND CONTROL PROGRAM AT THE SITEMAN CANCER CENTER AT BARNES-JEWISH HOSPITAL AND

Washington University School of Medicine, had identified a significant cancer cluster. This was the beginning of the Red Map Study. As a result of these findings, the Breast Health Outreach Program at the Joanne Knight Breast Health Center at Siteman developed an initiative to change the statistics. Its goal: to help a greater number of medically underserved women get mammograms. Major support from the St. Louis Affiliate of Susan G. Komen for the Cure® made the vision a reality.

 “Dr. Schootman’s study was a call to action,” says Susan Kraenzle, RN, manager of the Joanne Knight Breast Health Center. “It  helped us develop a focus for our outreach program. As a result, we doubled the number of women we serve. We work closely with our partners in local clinics and health departments who know the needs of the people they service.

 “Many of the women we serve would not have a mammogram unless the doctor or nurse in their clinic explains to them how mammograms can save their lives. We help them get the care they otherwise couldn’t afford. No woman is denied services based on her ability to pay.”

In 2009, the outreach program provided mammogram screenings to more than 2,600 underserved women. Most were reached through the Siteman Cancer Center Mammography Van. But it’s the program’s work beyond screening that makes it the largest outreach of its kind in Missouri.

“If a woman is suspected of having breast cancer through our screening, we offer her a full scope of services, including education, diagnosis and treatment,” Kraenzle says.

Making Mammography and Treatment More Accessible

Two years ago, Schootman reviewed the breast cancer rates in these “red map” areas again to see if mammography had impacted the numbers. It had. In 2008, the incidence of late-stage breast cancer in this population had normalized.

“This is most likely a result of the increased, more accessible mammograms,” Schootman says.

Kraenzle says the mammography van is integral to the outreach program’s efforts. “Our collaboration with the Federal Qualified Health Center in our area has helped us better reach underserved women. We bring the screening to where they live through the mammography van.  This aspect of outreach is critical for patients who lack transportation or confidence to negotiate what can be a complicated health care setting.”

The Breast Health Outreach Program is a key component of Siteman’s Program for the Elimination of Cancer Disparities (PECaD). The program also works with the hospital’s Daylight Project, which provides services to women who are new to the United States and have limited English proficiency and a variety of cultural needs.

Another important component in outreach is the Breast Health Patient Navigation service for women who come to Siteman for further testing and treatment.  Funding from the St. Louis Affiliate of Susan G. Komen for the Cure®  supports patient care as well as Patient Navigation services.

Breast Health Navigators are trained lay people from the community who accompany women at Siteman through the anxiety of the diagnostic process when a screening mammogram reveals something suspicious. “Some of these women will be diagnosed with breast cancer, and our Navigators will be right beside them, smoothing out a difficult journey,” Kraenzle says. “This program helps make sure women continue all the way through the process, from suspicious mammogram findings to a resolution in care. Our Navigators communicate well at all levels and are very passionate about helping people.”

She continues: “Everyone in the Joanne Knight Breast Health Center has a passion for helping others. Our outreach patients are able to receive treatment from top doctors with state-of-the-art technology in a world-class facility. Being able to offer that to these patients is wonderful.”

Identifying New Areas for Outreach

Recently, Schootman and his colleagues expanded the focus of the Red Map Study and looked to see where else in Missouri women were more likely to develop breast cancer. Again, the map lit up over a particular region. In this case, it was in western and northern St. Charles County.

“We found in this area, from 2001 to 2004, women older than 50 were 25 percent more likely to develop breast cancer than other women around the state,” Schootman explains.

As a result, a “calling study” was begun early this year to determine the reason for the cancer cluster. Over a three-month period, people were randomly called in the area and asked questions about mammography use, breast cancer risk factors, demographics and more.

Schootman says that Komen St. Louis has been instrumental in his epidemiological research. “If not for the Komen Affiliate, we wouldn’t be able to generate the maps for the study or conduct telephone interviews or realize other funding. If we determine that low mammography use is the root of this breast cancer rate in St. Charles County, we have several avenues to reduce the rate. Mammography is one way to tackle the issue. It’s satisfying to help identify interventions that can make such a difference.”

A Dire Need for Support

Despite the important impact the Breast Health Outreach Program has made, Kraenzle admits the economy has made their work difficult. “It has been a tough year for us. The state’s funding program, Show Me Healthy Women, has significantly cut funding to our outreach program, and they advised us that funding will be flat for the next few years. We’ve never had to tell anyone we can’t take care of them, but we’re running out of patient care funds.”

She says other providers expect funding shortfalls, too. “People look to Siteman and Barnes-Jewish for care as a safety net for the medically underserved. But we’re juggling funds from mammogram to mammogram. We’ve never been in this dire a situation before, and the challenge will continue for the next three to four years. We’re emptying all our buckets.”

Kraenzle’s Advocacy Work Leads to Nursing Award

Even before kindergarten, Susan Kraenzle, RN, knew she wanted to be a nurse and follow in her mother’s footsteps.

She began her career caring for babies in the neonatal intensive care unit at St. Louis Children’s Hospital. But a family move to Ste. Genevieve resulted in a new position as a nurse in women’s health. “I believe I’m always put where I need to be,” she says. “I saw a huge need for women’s health in southern Missouri.”

While she was living in Ste. Genevieve, she wrote her first grant after watching the Susan G. Komen St. Louis Race for the Cure® on television. The grant was for outreach to rural women. “The Komen organization soon called to tell me they had been waiting for a grant proposal to help rural women,” Kraenzle says. “Helping to establish that program was a big reward.”

A few years later, her ties to Barnes-Jewish Hospital led her back to St. Louis to become manager of the Joanne Knight Breast Health Center at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. Managing the Breast Health Outreach Program is one of her responsibilities.

Kraenzle’s dedication to preventing breast cancer is personal. Her sister died from breast cancer when she was just 42 years old, leaving behind three young children.

Because of Kraenzle’s patient advocacy to promote and improve quality cancer care and nurse advocacy, she was named the “St. Louis Nurse of the Year” by the Missouri Nurses Association (MONA), Third District, 2009.

“She’s dedicated her life to advocating for patients, both as a staff nurse and as an advocate for women’s health,” says Florence Speer, RN, vice president of MONA, Third District. “I nominated her, and we chose her for her advocacy on behalf of underserved women not only in St. Louis city and County, but also around the Bootheel and Ste. Genevieve.”

Through grants from Missouri’s Show Me Healthy Women Program and the St. Louis Affiliate of Susan G. Komen for the Cure®, Kraenzle oversees programs providing breast screening at no cost to thousands of women in underserved communities.

“It’s an honor every day to work with a tremendous group of people who allow us to care for women who otherwise would not be able to get this lifesaving care,” Kraenzle says.