Mammography Technician, Heather Buie

Our recent field visit took us deep in the Arkansas delta, to the small town of Rison, where the weather was cold and blustery. On that day, Rison was scheduled to host The University of Arkansas Medical Sciences (UAMS) mobile mammogram van, and the fact that even with the inclement weather, their schedule was full is directly attributable to the tireless efforts of a dedicated alliance – one with the shared objective of saving lives.

The Breast Cancer Relief Foundation (TBCRF) and the  UAMS / Winthrop P. Rockefeller Cancer Center are both committed to addressing the high incidence of breast cancer in underserved counties of Arkansas. With more than double the national average for detected breast cancers, the need in these counties is clearly critical. In response to this disturbing reality, UAMS has instituted an ambitious plan of service and outreach by utilizing their beautifully designed, new digital mammogram van, known popularly as their MammoVan. With the help of past and present funding assistance from TBCRF, a talented team of technicians, doctors, and volunteers work overtime to offer mammography screenings to poor and at-risk women throughout their state.    

The UAMS MammoVan has become a lifeline in Arkansas. Twenty-six counties in Arkansas have no FDA-approved mammography facilities. Most of these counties are poor and rural, and many obstacles converge to derail the possibility of early detection of breast cancer. No insurance, low income, lack of transportation to other counties for screening, and the inability to take time off from a job to travel, have been major hurdles in the past. The MammoVan now provides free screenings to these underserved rural women – right in their own community.

A model of efficiency, the program has been fine-tuned for optimal results. Volunteers, such as LaPrisha Bennett, begin the process by raising awareness and publicizing well in advance the arrival date of the mammogram van. She canvases her assigned area speaking to women’s groups, hanging notices throughout the community, contacting employers and health care professionals, and arranging radio announcements. This is a crucial first step and instrumental for success.

Early each morning, the van arrives in the designated community. Mammography technician, Heather Buie, and clinical technician, Shannon Strickland, are ready to go. Together they see up to 30 women a day. In total, since the program began in February 2010, over 3000 women have received mammograms! There have been 20 diagnoses of breast cancer and nine high-risk lesions detected. Many of these women have never been screened before and would very likely have gone without. Now, with repeat visits yearly, they are able to benefit from the same medical advances that many of us take for granted.

Meriel, one of the first patients to arrive, works at a dry cleaning store – a job that she and her husband rely heavily on for economic survival. Today, after her screening, she was all smiles. She explained that paying for a mammogram out-of-pocket would be impossible, so she was thrilled at the ease of today’s experience: “It’s very impressive. I am so thankful that I have the opportunity to get screened – and right here in Rison! I never thought it could be so easy and everybody was so nice. Thank you for making this possible!”     

Ruby’s last screening was over ten years ago.  Her husband has had heart disease and can no longer work as a millwright. Their fixed monthly income barely gets them by. Because of past scares with benign lumps, Ruby has been advised to have yearly mammograms. With no insurance, their income couldn’t begin to cover the costs for her needed screenings. Years passed, and she worried. Finally, today, she is here – receiving a free mammogram, elated with the knowledge that she will be able to return each year. Relieved, Ruby states, “It’s great because lots of people can’t go away to find screening. [The van] going out to all the small towns is really good because many people like me don’t know they can get help.”

An important aspect of the MammoVan’s process and success lies in the integration of these women and their families into the health care system. The staff works hard to ensure a thorough experience, navigating patients through any and all follow-up procedures if necessary. Additionally, it is a real hope that this program will help patients and their families to establish an ongoing relationship with their community health center where they can receive continued assistance and guidance with their general health care needs.

We are extremely proud to partner with UAMS and their MammoVan to serve women in need in Arkansas. Thanks to the strong support of our donors, this is only one of the many mammogram vans that TBCRF grant funding helps make possible across the United States. From small rural clinics near the Texas / Mexico border, to large metropolitan hospitals like Dana-Farber in Boston and MD Anderson in Houston, our goal is to give women of all incomes and backgrounds an equal opportunity to prevent, detect, and conquer breast cancer. We are honored to partner with the UAMS / Rockefeller Cancer Center to help fill the huge gap in breast cancer screening in Arkansas.

Cory Leigh Taylor, Director of Development for Cancer Initiatives at the hospital states, “The Breast Cancer Relief Foundation was one of the first organizations ‘on board’ with our digital mobile mammography program. Early on, you believed in our mission and helped us to achieve this incredible outreach program. Your support gave a much-needed boost of confidence to all team members and helped instill confidence to make it happen.”

Without the past and future contributions of our generous individual donors, these valuable programs would cease. We are grateful to our supporters for the opportunity to carry out our mission.

We’ve asked directions at least four times, lost in the meantime in a maze of unmarked dirt roads. Lost among sick dogs, loose chickens, hanging clothes, burning yard fires, children everywhere, weathered faces staring, and endless people sweeping endless dust.  Tropical growth is rampaging, and many houses have curtains for doors.  We were in Honduras in the city of San Pedro Sula, but in name only. This barrio is a life separate from the urban existence of the rest of the city.

Finally, we find the correct turn for Elba’s house, and she is out front.

We first met Elba the day before, when she was visiting the clinic FundalCancer, a non-profit organization in San Pedro. The Breast Cancer Relief Foundation (TBCRF) has donated Tamoxifen, a life-saving breast cancer therapy medication, to the foundation. FundalCancer then distributes the Tamoxifen and other of TBCRF’s donations to underserved women in Honduras for their breast cancer therapy. These life-saving medicines are financially beyond all reach for these women.

Elba’s difficulties began in 2005 when she felt a lump in her breast. She found a way to have a mammogram, and a tumor was indeed detected. The doctors ordered a biopsy immediately, but Elba could not afford to pay for this important procedure. Finally, in January 2006, she was able to scrape enough money together. The results dictated the need for an immediate lumpectomy, which was performed that very month. To her great relief, the accompanying lymph node dissection was negative. Elba received 25 treatments of radiation, and then started the regime of Tamoxifen in May 2006. But to be effective, she would have to continue this medication uninterrupted for five years.

Jose, Elba’s husband, is a construction worker, and before she became ill, Elba was a seamstress by trade. They have 3 children: a grown son and daughter and a seven-year-old daughter, who brings endless joy to her mother. When Elba got sick, her children worried that their mother might die. Elba’s mother was so frightened that she became ill from anxiety. Elba suffered from depression in the beginning, and confesses to bouts of crying. Now her eyes seem deep and gentle, her manner stoic and determined. “Now”, she states, “my entire family has learned that cancer is not a death sentence.”

The financial burden has been devastatingly difficult. At first, when she had to purchase the Tamoxifen herself, the family had to do without everyday necessities such as toothpaste, toilet paper, and enough food. She has not had the strength to get back to work yet, but peace of mind is returning. She is in remission and getting stronger by the day. And because she is benefiting from the TBCRF Tamoxifen donations, she feels confident again about her future. Hope has replaced fear.

The closeness of Elba’s family has helped see her through her illness. Her entire family lives in a compound of houses connected by a common central yard full of laundry, chickens, and family togetherness. Her elderly mother and father live in the primary house. Adjoining and surrounding the central outdoor area are Elba’s small home and that of her sister. It’s a warm and colorful household, a traditional, communal Honduran family.

To see her surrounded by the liveliness and love of her extended family, combined with the knowledge that continued therapy with Tamoxifin will greatly enhance her continued remission is to thoroughly understand the importance of TBCRF’s program to bring breast cancer aid to women of all nationalities and backgrounds.

Triple negative breast cancer is a particularly aggressive type of breast cancer that gets its name from the fact that it lacks the receptors found in other types of breast cancer: estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). When present, these receptors function in stimulating the growth of the tumor, and consequently can be specifically targeted with often good treatment success: the more common ER and PR positive breast cancers are usually treated with hormone therapy drugs such as aromatase inhibitors or tamoxifen, while HER2 positive breast cancer is treated with trastuzumab.

Lacking these receptors, triple negative breast cancer is typically more difficult to treat and has a poorer prognosis. The search for some type of targeted therapy, therefore, is the focus of various researchers seeking alternative, more effective treatment options for women with this type of breast cancer.

The Breast Cancer Relief Foundation (TBCRF) recently awarded Dr. Brian Rowan, Ph.D., Associate Professor of Structural and Cellular Biology, at Tulane Cancer Center in New Orleans, LA with a $60,000 research grant to pursue this exact purpose. This grant is particularly important for Tulane, which reported that in the past year over 40% of their breast cancer diagnoses were of the triple negative type, a percentage that is much higher than the national average, which is typically between 10% and 17%.

This high number of triple negative breast cancer patients in their cancer center’s care impelled several medical researchers at Tulane to redirect their research efforts to study this type of breast cancer more closely. Recognizing the very high presence of a protein known as Src (sarcoma viral oncogene) in triple negative breast cancer tumors, Dr. Rowan and his team of scientists sought out a drug that would specifically target this protein, and they came to learn of the new experimental drug, KX-01, which was created by Kinex Pharmaceuticals.

Since no other laboratory anywhere was studying the use KX-01 for triple negative breast cancer, TBCRF was very proud to provide grant funding to Dr. Rowan and his team to pursue this very significant investigation. The results of their preclinical research were very encouraging: KX-01 was found to act as a Src inhibitor by binding directly to this protein in triple negative breast cancer cells; it significantly reduced tumor sizes; and it demonstrated low toxicity, which would indicate minimal side effects in actual treatment situations.

Their research also demonstrated an increased positive result when KX-01 was combined with traditional, broad-based chemotherapy agents such as paclitaxel and doxorubicin. This combination dramatically reduced tumor sizes during the same 36-day period.

Most exciting, however, was their observation that there was an added benefit when KX-01 was used in combination with hormone therapies traditionally used for ER and PR positive breast cancer. In the course of their experimentation, they made the very important discovery that KX-01 “turned on” the estrogen receptors in triple negative breast cancer cells. This change in the tumor cell created an environment in which the triple negative breast cancer could now be treated more effectively by using a combination of KX-01 and tamoxifen.

The impressive research of Dr. Rowan and his team on this combination appears to be a very promising new targeted therapy for this unique type of breast cancer that has, heretofore, had little success in targeted treatment. This past month, TBCRF staff toured Dr. Rowan’s lab and met with him and his team to hear firsthand of their results and where this research might lead. Dr. Rowan expressed his gratitude to TBCRF for the research grant which helped enable his preclinical study of KX-01, and he happily reported: “Data from these experiments has provided the critical rationale needed to initiate a clinical trial of KX-01 for triple negative breast cancer patients in New Orleans.” A “probe trial” with 43 patients will begin soon, and we are all very hopeful for the success of this new targeted treatment.

A sturdy, capable woman, Margarita has an air of competence.  Although her life has been anything but easy, her eyes dance merrily when she speaks.

Born and raised in the dusty town of Carrizo, Texas, only a few miles from the Mexican border, poverty has always been part of the picture. Most families from this area are, or were, part of the migrant farming work force. Margarita wasn’t going to settle for the hard-work, low-pay lifestyle of her parent’s generation. After school, she moved to Mexico for eight years – trying her hand at making a living there. But the United States was her home, and she moved back to Carrizo and got married.

Her husband is a dozer operator and truck driver, and for years he made an adequate wage. For awhile, Margarita found work that she loved as a secretary in Eagle Pass, on the US side of the border. They began their family and had two children. They felt that their life was on a positive path.

But as the economy worsened, jobs for her husband became scarce, and then she lost her secretarial job. Finally, her husband was totally out of work options and they were scrounging to feed the family. Frightened that they couldn’t afford to take the children to the doctor if they got sick, she found the Vida Y Salud Health Care clinic, in nearby Crystal City. This clinic exists to provide low-income families with quality health care for free or on a sliding scale. They never turn a patient away due to inability to pay.

One of the clinic’s most important services is their Women’s Health program. Women in this south Texas region are crucial to their families as parents and as breadwinners. The Breast Cancer Relief Foundation’s Mammogram Access Program has awarded the Vida Y Salud clinic a grant to provide women of the area free mammograms.  The clinic has arranged a partnership with Uvalde Memorial Hospital to perform these screenings. A forty-five minute drive away, it is the closest facility with a mammogram machine to Crystal City. Margarita was thrilled at this opportunity. Concerned that she should begin her breast cancer screening, she also knew that her financial situation in no way allowed her to pay for a mammogram. She had even investigated the possibility of arranging a payment plan, but there was no nearby facility even offering mammograms.

With the new TBCRF grant to Vida Y Salud, her problem was solved. She scheduled her appointment on one of the twice-monthly screening days. And because she didn’t have transportation, the clinic picked her up in the company van. This transportation is provided for all the ladies receiving mammograms. They are brought to the hospital and returned to their homes at the day’s end.

Through her massive determination to maintain a higher standard of living for her family, Margarita finally procured a job at a local lumber store. She is a dedicated employee and is working to improve her pay-level and status. She has ambitions to move back into secretarial work. She is fully aware of her importance to her family and grateful to have one less obstacle in her path.

“This is a life experience here…an experience I will never forget,” remarked Ted Duggan, Vice-Chairman of the Board of Directors for The Breast Cancer Relief Foundation (TBCRF), as we made our way out of Hospital San Felipe and walked quietly to our car. We had just spent the morning at this general hospital in Tegucigalpa, Honduras, where we met with patients and received an eye-opening tour from the very jovial Dr. Ivan Pinto, a surgical oncologist at San Felipe.   His great passion for his work was obvious as was his positive attitude, which is simply remarkable given the overcrowded, short-staffed, and undersupplied condition of the hospital.

Honduras is the second poorest country in Central America, and sadly the situation at Hospital San Felipe is not unique. For those without financial means – which is the majority of the population – access to basic medical care is extremely limited and for those with serious illness, they must travel to the public hospital at San Pedro Sula or the capital, Tegucigalpa, where their care is often limited by the facility’s meager resources.

For the past five years, TBCRF has been very active in Honduras, where we have provided tens of millions worth of donated medicines to public hospitals, clinics, and charitable organizations in the country. This trip to Honduras, we came not only to monitor recent donations and assess current unmet needs, but also in response to an invitation to meet with the First Lady and the Minister of Health.

At the presidential palace, we presented First Lady, Rosa Elena de Lobo, and Minister of Health,  Dr. Arturo Bendaña Pinel, with a donation of Tamoxifen and discussed new ways that we might work together to assist women in need in Honduras, including possible future support for a mobile mammogram program that the First Lady and the Minister of Health recently initiated. Minister of Health Bendaña explained to the media the importance of this vital breast cancer medicine, pointing out that breast cancer is the second leading cause of death for women in Honduras.

Though our meeting ended with smiles and hugs, our delegation left not with a feeling of pride for work having been done, but rather with a sense of motivation for new ways to serve women in need.

First Lady, Rosa Elena de Lobo, Minister of Health, Dr. Arturo Bendaña Pinel, and TBCRF's Dr. Michael Whitehouse speak to the press.

In spite of a double mastectomy, 16 rounds of chemotherapy, and finally radiation treatments, Cyndi is in a great mood. 

Her diagnosis of breast cancer was a difficult moment, but not a huge surprise. Her sister, too, was diagnosed with breast cancer and died seven years ago. Since then, Cyndi (now age 50) has done everything in her power to get her yearly mammograms. 

But in 2006 her husband’s job was eliminated and he was put in a new position, at only one-third of his former income. Insurance was not provided, and health care became a serious challenge. Mammograms and regular screenings were not affordable for the couple. 

The Breast Cancer Relief Foundation (TBCRF) has met far too many women who do not have access to mammogram screening because of lack of insurance, inadequate coverage, or financial hardship. Through our Mammogram Access Program, we are providing grant funding to cancer centers throughout the country like the Mary Bird Perkins Cancer Center in Baton Rouge, which gives free mammograms to low-income and uninsured patients. Their mammogram van has an ambitious schedule and screens approximately 2500 people a year. TBCRF is also providing funds to the Center through our Patient Relief Program to assist breast cancer patients with the often overlooked incidental costs like transportation, lodging, and co-pays, that often create serious obstacles that cause patients to miss appointments or discontinue their necessary treatments. 

Today, Cyndi is in a great mood because she is ready for her last radiation treatment at Mary Bird Perkins and she feels fantastic. She credits her success with early detection, great care, and the help with her expenses from TBCRF grants. She explains the sense of family she has developed with her care-givers, who she credits for always building her spirits up when she felt exhausted and “making me feel good about myself”. 

She has many more words of praise for Mary Bird Perkins Cancer Center and TBCRF. “My experience is so different from my sister’s, because of early detection. It’s all about that! And the gas cards were huge. My trips for treatment from my home in Mantz were too expensive for our small income. The gas cards were the only way I could afford to get here – they were just a huge part of my recovery.”

Many minority and low-income residents routinely face linguistic, economic, cultural, and logistical roadblocks that prevent adequate health care access, even as medical advances are racing forward for the more affluent.

Dana-Farber’s Community Benefits Program is the Institute’s division devoted to reducing cancer risks for low-income populations in the greater Boston area. Working with community organizations and neighborhood health clinics, Dana-Farber Institute has built a network of sustainable programs to address this disparity of cancer detection and care.

One of their most impressive success stories is the Mobile Mammography Van. Reaching inner city housing developments, ethnic communities, and outlying villages the van is bringing screening opportunities where none previously existed.

Since 2002, the van has provided over 25,000 mammograms, and in 2009 it screened almost 4,000 patients. Emphasis is placed on notification of yearly revisits and in 2009, 64% were return patients.

The Breast Cancer Relief Foundation (TBCRF) is proud to be a longstanding supporter of the Dana-Farber program. We believe, as they do, that all women deserve the opportunity to conquer breast cancer – and early detection is the most vital issue in this fight. Statically, 1 in 8 women in the United States will develop breast cancer within their lifetime, but the survival rate has grown to almost 90%. With many new advances in treatment options for breast cancer, this disease has become eminently treatable, especially when diagnosed at an early stage.

TBCRF has supported annual grants to underwrite expenses for the van, and last year, we helped them purchase a new van outfitted with state-of-the-art digital mammography equipment. The new digital capability allows more accurate screening with less patient callbacks, resulting in a higher individual screening total.

Dana-Farber and the community health clinics also provide social service navigators and translators for all patients to help them understand and utilize the full extent of health care services available to them in Massachusetts. This brings hundreds of formerly ‘off-the-radar’ individuals and families into the system to receive free or low-cost health care.

During our most recent visit, we had the pleasure of meeting a few core members of the team. Mammogram van technologists, Donna Orlando and Ellen Moore, along with Kayla Zaremski, the van case worker/navigator, are passionate and committed advocates, working long days in the field when the van is out. Patients have come to know and trust them, looking forward to their yearly appointment. Maureen Akisik, the Supervisor of Breast Imaging, works tirelessly to ensure a seamless van-to-radiology-to-patient experience. Heading up the group is Anne Levine, Vice President of External Affairs, who has brought the process to the high level of efficiency it currently holds. The many thanks that they gave us for our support was truly humbling as we watched them in action serving women in need.

The 63 patients diagnosed with breast cancer from screenings performed on the van provide statistical evidence of the value of Dana-Farber’s mammogram van program. More importantly, it means that 63 underserved women have had the benefit of early detection and a helping hand to find the treatment options that are available. These 63 women, who because of lack of means, might otherwise have been overlooked, undiagnosed, and untreated, have been afforded the opportunity to fight and conquer their breast cancer. That is the goal of TBCRF and the Dana-Farber Cancer Institute!

Dr. Anthony Lucci, Jr., associate professor in the Department of Surgical Oncology at The University of Texas M.D. Anderson Cancer Center, is an energetic, articulate proponent of his exciting research into breast cancer metastasis. When he speaks of his work it becomes impossible to resist his enthusiasm. Our visit to his lab was an invigorating and educational experience. The NIH and the Department of Defense thus far have funded his research, but now more funding is needed to continue and conclude his groundbreaking theory.

Breast cancer is the most common cancer among American women (excluding skin cancers) with every woman having a greater than 12% chance of developing this disease within her lifetime. Dramatic improvements in breast cancer diagnosis and treatment have greatly increased survival rates; however, breast cancer remains the leading cause of death among women aged 40 to 55 with most deaths being a result of metastasis of the disease to other parts of the body. In about 1/3 of these cases the metastasis is too small to be detected by any diagnostic testing available today. These micrometastases can potentially remain dormant in bone marrow for long periods of time and are usually resistant to traditional cancer therapies.

Dr. Lucci is researching ways to identify and eradicate breast cancer micrometastasis. Research has revealed that breast cancer tumors send cells to the blood and bone marrow early in the disease, but doctors have never had the information and understanding in place to identify micrometastases in their cancer patients.

In the past, Dr. Lucci’s research has focused on methods of detecting and identifying bone marrow and circulating blood stream metastasis. Through his research, he is now able to successfully profile micrometastatic cells and identify new targets to prohibit metastasis. In a recent paper he states, “This focus on early detection of micrometastases represents a completely novel approach, in which the risk of recurrence could be determined from the presence of cancer cells in the blood and bone marrow, and treatment decisions could be based on the specific characteristics of the micrometastatic disease…Therefore, eradication of micrometastases— before they can become clinical metastases—is essential to improve outcomes in breast cancer.”

With this knowledge, Dr. Lucci is ready to move ahead to clinical trials. He will “identify, monitor and target micrometastases to improve patient outcomes”. This will lead to targeted therapies tailored to each specific patient.

The ramifications of this research are far-reaching. Many women’s lives could be saved and breast cancer treatment revolutionized. He fully expects the opportunity for women to benefit from these developments to be 5 years – a very short time frame in the world of medical research. Furthermore he anticipates that his research will be subsequently utilized to fight numerous other cancers. Our time with Dr. Lucci filled us with great enthusiasm and hope, and we are very proud to be supporting him with grant funding through our Breast Cancer Research Program.

Elizabeth’s soulful eyes mirror her patient and powerful personality. Only thirty-eight years old, her life has already seen deep lows and great joys.

A mother of 4, including twin girls, Elizabeth felt more fortunate than many in her country. She held a job she loved – as a pre-school teacher – and her husband, James, worked as a bricklayer. They struggled economically on an income of only a few dollars a day, but were happy to have employment and a stable, loving, close-knit family.

One year ago, Elizabeth’s dearly held contentment came crashing down. She experienced a strange combination of pain in one breast and a lump in the other. She was unprepared for her diagnosis – breast cancer.

Living in the western region of Ghana, Elizabeth was able to find a regional public hospital to perform the advised lumpectomy, but when the lump reoccurred fairly quickly, she was referred to a woman’s care hospital in Kumasi. This, unknown to her at the time, was key to her health. Due to the hospital’s commitment to fighting breast cancer in all women, regardless of financial resources, she was able to receive top-notch care and therapy. Her comprehensive plan for treatment consisted of chemotherapy followed by a mastectomy and now several more rounds of chemo.

Compiling every bit of money the couple had ever made would have been insufficient to cover the costs. But despair was replaced by joy when she understood the hospital’s policy of help.

The Breast Cancer Relief Foundation, also dedicated to helping underserved women fight cancer, has helped make this program possible. By donating significant quantities of chemotherapy medication to aid in the treatment of these women in Ghana, patients who could not have received cancer treatments now have the ability to fight back.

Elizabeth’s life is still a challenge. The family lives about five hours away, making the long bus trips an expensive and painful fact of life. During chemotherapy cycles, she stays with her brother-in-law, about two hours away from the hospital. Unable to continue working, she was devastated to give up her job. James took charge of their children, but now has lost much of his business. These issues to Elizabeth, while hard, are bearable with the knowledge that she has the opportunity to fight this cancer and recover.

Her parting message to us was straightforward and honest: “You should bring more and even more – so these medicines are available to each of us here.”