By Judith Newmark, St. Louis Post-Dispatch, October 23, 2008

Estella Cammack, with her soft-spoken manner and ladylike bearing, appreciates how odd a circle of thick white greasepaint looks on her delicate brown face.

"Boo!" she exclaims with a chuckle. "Do I look scary?

"Good. Because breast cancer is scary."

A 10-year survivor of the illness, Cammack wants to make sure that other women aren''t too scared to take care of themselves. She belongs to the St. Louis chapter of the Witness Project, a national organization of black women that encourages fighting cancer with early detection: pap smears, mammography, clinical breast exams and breast self-examination.

Members of the St. Louis group go to churches, businesses and women''s organizations to "witness" to the importance of early detection. Like the members of other chapters around the country, they tell personal stories and provide information about community health services. But about a year ago, the St. Louisans came up with a vivid new twist on their program: mime.

They teach breast self-examination by acting it out.

As one member of the troupe reads aloud, the others demonstrate with the stylized movements of mime. It''s not an exact breast exam, but it suggests each step of the process. Taken all in all, it turns into an elegant little performance, not without humor (self-examination, the reader explains, is "like looking for a raisin in a three-layer cake") and with definite flair. The Witness Project''s show looks a little like a modern dance, or an avant-garde performance art piece.

And since it debuted about four years ago, it has brought its message of self-awareness to about 8,000 people all over St. Louis.

Breast health issues have trod the boards before. In 1994, Susan Miller received Off-Broadway''s Obie award for her autobiographical stage memoir, "My Left Breast." Its many successors include "The Hands Shape" by Ruth Cantrell, "Purple Breasts" by Allaire Koslo and "Unravelling the Ribbon" by Mary Kelly and Maureen White. There''s even a new musical, "Love in the Time of Breast Cancer," opening next month in San Francisco.

But none of the Witness Project volunteers had ever performed in a play before, let alone in mime. The whole thing seemed to come out of nowhere.

Actually, it came out of the mind of Michell Nickerson, who dreamed it up at church.

Mime performances are sometimes part of praise worship services; as a rule, the mimes act out religious songs. Why not use the same technique, she wondered, to teach women a memorable lesson?

Nickerson is coordinator of the project, a part of the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; the St. Louis affiliate of Susan G. Komen for the Cure helps fund it. She brought her inspiration to members of the Witness Project, a group of some 50 volunteers, about half of whom have had breast cancer. They saw the possibilities at once, and Nickerson wrote up a script.

St. Louis actress Shawn Guy-Pitts stepped in to choreograph the piece in mime style, known for its formal, deliberate movements. Then she taught it to about a dozen Witness Group volunteers.

Learning that took "practice, practice, practice!" said volunteer Lillie Allen. "But we knew that a performance could give women better insight than (reading instructions on) a card."

In the performance, the women dress identically in flowing black tunics and palazzo pants. Most arrestingly, they paint their faces white, as mimes traditionally do. Nickerson took a clown class to learn the makeup technique, then taught the others.

Volunteer Ann Vaughn says that the makeup is a big plus, a hedge against stage fright. "When we''re in makeup, you don''t know who we are," Vaughn said. "I''m shy. My friends can''t believe I do this."

But as a two-time survivor of breast cancer, Vaughn feels compelled to involve herself in the effort because "early detection is the key." The whole idea is to bring that message to women who may not have heard it before.

White women are more likely to survive breast cancer than black women. In St. Louis, for example, mortality among white women declined about 21 percent in a recent 15-year study, but mortality among black women declined by only about 10 percent over the same period, said Dr. Mario Schootman.

An epidemiologist at the Siteman Cancer Center, Schootman said that about half of the improvement is due to better treatment and about half to better screening. Better screening means finding cancer sooner.

"There are lots of potential reasons" for the racial difference, Schootman said. For one thing, certain types of aggressive tumors are more likely to occur in young black women than in white women; these tumors are harder to treat. But apart from the mysteries of cancer, issues of screening remain.

That''s where the Witness Project comes in. Founded at the Winthrop P. Rockefeller Cancer Institute in Little Rock, Ark., the project aims to increase cancer screening among black women by erasing stigma, explaining health services that are available to women even if they are uninsured or underinsured, and making women feel comfortable talking about health issues. The organization often works with churches and other places where volunteers may reach women who don''t ordinarily seek medical care for themselves.

That''s a lot of women, Vaughn believes. "Many women are nurturers of other people," she said. "We don''t tend to take the time to nurture ourselves." Also, Nickerson said, a lot of women are so afraid of breast cancer, or hold such mistaken ideas about treatment, that they don''t check things out.

The Witness Project wants to break those barriers down. "We can take away a lot of the fear," Allen said. "But you''ve got to talk about it. You have got to take care of business."