NEW YORK CITY COUNCIL OVERSIGHT HEARING:BREAST CANCER SCREENING | NYC Health + Hospitals

NEW YORK CITY COUNCIL OVERSIGHT HEARING:BREAST CANCER SCREENING

NEW YORK CITY COUNCIL OVERSIGHT HEARING:BREAST CANCER SCREENING

Ross Wilson, MD, FRACP, FJFICM
Acting Senior Vice President
Deputy Chief Medical Officer
New York City Health and Hospitals Corporation

Good afternoon Chairpersons Rivera and Mealy and members of the Committees on Health and Women’s Issues, I am Dr. Ross Wilson, Acting Senior Vice President and Deputy Chief Medical Officer for the New York City Health and Hospitals Corporation (HHC). I am joined here this morning by Dr. Lynn Silver, the Assistant Commissioner for the Bureau of Chronic Disease Prevention and Control of the New York City Department of Health and Mental Hygiene. Thank you for the opportunity to discuss recent announcements that have been made regarding breast cancer screening.

I would like to begin by saying that HHC continues to extensively promote the early detection and treatment of breast cancer as the primary tool for reducing the burden of disease. Our policy has not changed.

HHC’s clinicians screen for breast cancer through providing clinical breast examinations and mammograms for women aged 40 years and older regardless of ability to pay. Last year, HHC’s 16 hospitals and diagnostic and treatment centers provided more than 72,000 mammograms. HHC facilities use state-of-the-art digital mammography systems that produce digital breast images through computerization rather than traditional X-ray film, substantially increasing image resolution and reducing delays in generating results. I would like to thank members of the Council for providing funding for some of these digital mammography systems in prior City budgets.

The impact of breast cancer in New York City is significant. According to the Health Department, nearly, 5,000 women are diagnosed with breast cancer each year and more than 1,100 women died of breast cancer in 2007. Approximately three-quarters of new cases of breast cancer (2002-2006) and 86% of breast cancer deaths occur in women age 50 and older, but 18% of cases and 10% of deaths occurred in women ages 40-49. Mammography screening rates for breast cancer are high across the city at 78% in 2008. Rates of screening are similar or slightly higher in black and Latina women compared to white women, but lower in Asian women. In 2008, uninsured women were significantly less likely to be screened, 62%, in contrast to 80-82% for the insured. Screening rates are slightly lower in women age 40-49. While black women in New York are screened at the highest rate, they die more than any other group of women.

Breast cancer screening is effective at reducing mortality. But it is a less effective screening test than some other cancer screens. Even if all women over 40 are screened annually, mammography alone will prevent fewer than one-sixth to one-third of deaths, and so should not be our only strategy for reducing breast cancer deaths. Promoting mammography can and should remain a critical part of our efforts to reduce the burden of breast cancer on New York City women. Around the City, the main barriers to screening are lack of insurance and co-pays or deductibles – however, at HHC, we provide mammograms regardless of ability to pay. HHC and the City support key provisions of federal health care reform that would eliminate co-pays and deductibles for preventive care like breast cancer screening.

HHC closely monitors the availability of mammogram services and utilization of such services in women who are most at risk of breast cancer. We believe that we can only achieve optimum quality of care through rigorous self monitoring and by resolving issues that may impede the proper delivery of health care services to the population we serve. Of the 72,000 mammograms provided last year, many of these were for women who did not have health insurance or the ability to pay for such procedures. Any woman who does not have a primary care provider, or “medical home”, can go to an HHC facility, register to become a patient and receive her annual mammography and any other services she needs.

HHC is committed to ensuring that a woman’s lack of insurance coverage does not pose a barrier to accessing mammograms and needed care. HHC staff help patients obtain public health insurance for which they are eligible. We also offer services at little or no cost through the HHC Options fee-scale program.

The prevention of breast cancer continues to be challenging as the specific causes for breast cancer remain elusive. Furthermore, except for smoking, obesity, and lack of exercise, most of the risk factors associated with breast cancer cannot be easily controlled or prevented. The risk factors include:

  • age (more common among women aged 50 and over);
  • race (more common among Caucasian women, although mortality is higher among African-American women);
  • family history of breast cancer (more common among those who have close blood relatives with breast cancer);
  • early onset of menstruation (more common among women who had onset of menstruation at age 12);
  • no children or late onset of pregnancy (more common among women who have no children or had first pregnancy over the age of 30); and
  • did not breastfeed (women who breastfed for longer duration seems to have lesser risk for breast cancer).

In light of recent opinions and recommendations that have been published on the value of screening, it is critical to emphasize public education on the need to have a mammogram and importance of the doctor-patient relationship. HHC has traditionally conducted extensive public awareness and outreach efforts concerning the importance of cancer screenings throughout the year, but we specifically focus on breast cancer screenings in May when we sponsor our annual Mother’s Day Mammogram Campaign.

The Mother’s Day Mammogram Campaign is designed primarily to reach underserved women. The campaign stresses the importance of having a mammogram, an important and potentially life saving procedure. This multimedia effort has featured both radio and newspaper advertisements with wide circulations in minority and new immigrant communities. Materials are provided in multiple languages to community based organizations, many of whom serve non-English speaking communities. We also link them to a primary care provider if they need one.

In addition to conducting public awareness campaigns, we recognize the importance of patient-provider relationship and encourage our providers to promote breast cancer screening to their patients. The provider’s advice to the patient on the need for a mammogram is invaluable. We also recognize how important it is for our providers to keep up-to-date on evidence based practices so that they can provide the highest quality care and advice to their patients. We conduct periodic educational programs for our providers on breast cancer screening, and the effective management of breast cancer. The decision to undergo a mammogram is taken by a patient, in conjunction with their physician. Their physicians are familiar with the evolving scientific evidence and will make a recommendation for screening which reflects that evidence and the individual patient’s particular clinical situation.

In addition to mammography, there is also a need to focus efforts on reducing the numbers of New Yorkers at risk for breast cancer. An important part of the prevention equation is promoting changes to lifestyles that contribute to the breast cancer burden. Studies suggest that as many as 35% percent of breast cancer cases can be attributed to obesity, lack of physical activity, lack of breastfeeding, and alcohol consumption.

The Health Department promotes risk reductions through two major initiatives:

  • A broad, multidimensional plan to prevent obesity by increasing access to healthy foods,
    decreasing consumption of unhealthy foods, and getting New Yorkers moving. As you know much of this work is being done in partnership with the City Council, and
  • Targeted efforts for low-income, first-time mothers and their infants to encourage breastfeeding, through the Newborn Home Visiting Program, Nurse-Family Partnership, and other programs.
  • Contact: Ian Michaels (HHC) (212) 788-3339

    About HHC

    The New York City Health and Hospitals Corporation (HHC) is a $6.7 billion integrated healthcare delivery system with its own 420,000 member health plan, MetroPlus, and is the largest municipal healthcare organization in the country. HHC serves 1.4 million New Yorkers every year and more than 475,000 are uninsured. HHC provides medical, mental health and substance abuse services through its 11 acute care hospitals, four skilled nursing facilities, six large diagnostic and treatment centers and more than 70 community based clinics. HHC Health and Home Care also provides in-home services for New Yorkers. HHC was the 2008 recipient of the National Quality Forum and The Joint Commission’s John M. Eisenberg Award for Innovation in Patient Safety and Quality. For more information, visit www.nychhc.org/hhc or find us on facebook.com/NYCHealthSystem or twitter.com/NYCHealthSystem.

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