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    "ocrText": "BREAST CANCER\nRADIO ADDRESS\n86:23 FROM:WOMENS OFFICE\n502-455-7311\n10:65507\nPRGE:01\nunited HOUSE\nWASHINGTON\nOFFICE FOR WOMEN'S INITIATIVES AND OUTREACH\nTO: Sara Bianchi\nFAX: 6-5557\nDATE: 10/23\nNUMBER OF PAGES (Including cover sheet): $ 22\nFROM:\nAudrey Tay3e Haynes, Director\nSondra Seba, Agency Representative\nRobin Leeds, Agency Representative\nOther\nNOTES:\nFINAL Briefing\npaper - Bulmail\nof members attending.\nTHE WHITE HOUSE\nOFFICE FOR WOMEN'S INITIATIVES AND OUTREACH\n708 JACKSON PLACE, NW\nWASHINGTON, DC 20503\nPHONE: (202) 456-7300 FAX: (202) 456-7311\nThe information contained in this facsimile message is CONFIDENTIAL and intended for\nthe recipient ONLY. PLease call If there are any problems with this transmission.\nPRESIDENT AND THE FIRST LADY ANNOUNCE NEW INITIATIVES TO IMPROVE\nPREVENTION AND EARLY DETECTION OF BREAST CANCER\nEmbargoed Until October 25, 1997\nToday the President and the First Lady announced new steps to ensure that more women get\nregular, high quality mammograms. Early detection, followed by prompt treatment, can reduce\nthe risk of death by as much as 30 percent. However, a mammogram can fail to do its job because\nof poor medical techniques, processing or reading of the films; inadequate record keeping and\nreporting of results, and lack of effective quality assurance controls. In 1995, about 35 percent of\nmammography facilities that sought accreditation initially failed the quality requirements.\nMoreover, far too few women get regular mammograms. Thirty-three percent of women ages 50\nto 64, and 45 percent of women over age 65 reported not receiving a mammogram in the last two\nyears. The initiatives the President and the First Lady are announcing today include:\nImproving Quality Standards of the Mammography Facilities Nationwide. The new FDA\nregulations announced today, authorized by the Mammography Quality Standards Act (MSQA),\nset new high standards for mammography facilities. They include important new clarifications\nthat require facilities to hire capable technologists, to use equipment that produces clear and\naccurate images, and to ensure that physicians have the skills to interpret the rules. It also requires\nfacilities to display their FDA certification, so women and their families know they have met the\nquality standards. They also require that patients be fully informed of results of a mammogram SO\nthat follow up testing and treatment can begin immediately. These new standards will ensure\nwomen receive high quality, accurate mammograms. The National Breast Cancer Coalition\napplauded the implementation of the final regulations stating that \"this Rule will ensure that every\nwoman in America will receive the highest quality mammography.\"\nInitiating a New Mammography Education Campaign at the National Cancer Institute\n(NCI). Today, the NCI is initiating a new national education campaign that provides women and\ntheir families and health professionals clear, up-to-date information about steps they should take to\ndetect mammography and breast cancer. The materials being released have been developed to\neducate women about the recommendations made by NCI this spring that women in their 40s and\nolder should get regular screening mammograms. The NCI materials will be released to\ncommunity organizations, doctor's offices, and other health care facilities around the country,\nproviding education about the risk factors for breast cancer, the benefits and limitations of\nmammography, and the importance of regular mammograms for women in their 40s and older.\nThey also highlight breast cancer incidence and mortality rates for women in different racial/ethnic\ngroups.\nLaunching the First Lady's National Annual Medicare Mammography Campaign. Each year the\nFirst Lady has launched a mammography campaign to encourage older women to get mammograms.\nDespite the fact that mammography can significantly reduce mortality rates, 45 percent of women over\nage 65 have not had a mammogram in the last two years. To encourage more older women to get regular\nmammograms, this year the First Lady's campaign includes:\nNew Nationwide Public Service Announcements to Encourage More Older Women to Get\nMammograms. Today, the First Lady is announcing two new public service announcements to\nencourage older women to get mammograms. One of the PSAs features Candice Bergen and was\naired this week at the close of the Murphy Brown Show. The second PSA includes breast cancer\nsurvivor and spokesperson Carol Baldwin and her sons, Alec, William, Daniel and Stephen. In\naddition to these PSAs, a number of corporations have made important new commitments to\neducate women about the importance of regular mammography and screening.\nHORIZON Grants to Improve Mammography Rates Among Minority Women. This year\nHCFA has focused the Medicare mammography campaign to reach minority Medicare\nbeneficiaries who are even less likely to get mammography screenings. HCFA launched Horizon\nProject grants, a three-year initiative in six major cities which focuses efforts on increasing\nmammography rates among Hispanic and African-American Medicare beneficiaries. These\ncomprehensive efforts will not only encourage more women in these areas to get regular\nmammograms but provide insight on how to overcome barriers that prevent women from getting\nmammograms. This week, we received the project's first report, and it is teaching us a great deal\nabout how to identify barriers including lack of awareness about the Medicare mammography\nbenefit, language barriers, and misconceptions that only women of childbearing are at risk for\nbreast cancer, and strategies to overcome them.\nThe Initiatives Being Announced Today Build on the President's Strong Record in the Fight\nAgainst Breast Cancer.\nThe Balanced Budget Act Made Medicare Mammograms More Affordable and Accessible.\nThe balanced budget the President signed into law this summer took steps to encourage more\nwomen to get regular mammograms by waiving deductibles for all mammograms and covering\nmammograms on an annual basis. Although Medicare has covered screening mammography since\n1991, only 14 percent of eligible beneficiaries without supplemental insurance receive\nmammograms, indicating that cost can be a significant barrier. The balanced budget also\nexpanded coverage to pay for annual screening mammograms all Medicare beneficiaries age 40\nand over making coverage consistent with the new recommendations of national experts.\nEarlier in the year, President Clinton took action to bring Medicaid and Federal Employees Health\nBenefits in line with the new recommendations.\nThe President Has a Long Record in Fighting Breast Cancer. The President has taken a\nnumber of important steps to fight breast cancer. Since the President took office funding for breast\ncancer research, prevention and treatment has nearly doubled to over $500 million in 1997; the\nCDC breast and cervical program which provides screening low-income women has expanded\nnationwide; new space technology has been applied to research to gain valuable knowledge\nimportant about detection and treatment of breast and ovarian cancer; and funding has increased\nfor an unprecedented partnership at the Department of Defense between the military, scientists,\nphysicians and community members for grants to invigorate breast cancer research.\nCLINTON ADMINISTRATION INITIATIVES TO FIGHT BREAST CANCER\nIntroduced Legislation to Prevent Discrimination Based on Genetic Information.\nThe President has urged Congress to pass bipartisan legislation to prohibit health plans\nfrom inappropriately using genetic screening information to deny coverage, set\npremiums, or to distribute confidential information. For many diseases, such as breast\ncancer, we are beginning to identify hidden genetic disorders which can spur early\ntreatment. However, genetic testing also can be used by insurance companies and others\nto discriminate and stigmatize groups of people. In fact, studies show that a reason\nwomen do not get genetic testing for breast cancer is because they fear the information\nwill be used to discriminate against them.\nExpanded Medicare to Pay for Annual Screening Mammograms for all Medicare\nBeneficiaries Age 40 and Over. The balanced budget expands coverage to pay for\nannual screening mammograms for all Medicare beneficiaries age 40 and over, enabling\nwomen to follow the National Cancer Institute's (NCI) recommendations to undergo\nregular mammogram screening at age forty. President Clinton has also taken action to\nbring Medicaid and federal employee health benefits in line with NCI recommendations.\nMade Medicare Mammograms More Affordable and Accessible. The balanced\nbudget enacted by the President this August waived deductibles for all screening\nmammograms, making annual mammograms more affordable for older women. Costs\ncan be a significant barrier for older women to get mammograms. Although Medicare\nhas covered screening mammography since 1991, only 14 percent of eligible\nbeneficiaries without supplemental insurance receive mammograms.\nBuilt on HHS Commitment to Breast Cancer Research, Prevention and Training.\nSince the President took office, funding for breast cancer research, prevention and\ntreatment has nearly doubled, from about $276 million in FY 1993 to an estimated $513\nmillion in the President's FY 1997 budget.\nContinued Department of Defense Funding for Breast Cancer Research. In FY\n1997, the DOD will spend $112 million on breast cancer research. This is an\nunprecedented partnership between the military, scientists, physicians, and the\ncommunity to fund grants to invigorate breast cancer research. One of the most\nimportant and innovative aspects of the program is that breast cancer survivors are\nactively engaged in defining the program and serve on scientific panels which review\ngrant proposals.\nIncreased Funding for Genetic Research. HHS-funded research led to the discovery of\ntwo breast cancer genes BRCA-1 and BRCA-2 -- which holds great promise for the\ndevelopment of new prevention strategies. On October 26, 1996, President Clinton\nannounced $30 million in new funding for research into the genetic basis of breast cancer.\nEducated Older Women to Use the Medicare Mammography Screening Benefit.\nThe First Lady has launched a yearly mammography campaign to inform and encourage\nolder women to use the Medicare mammography screening benefit. Despite evidence\nthat early detection through mammography and clinical breast exams is essential, 45\npercent of women over age 65 report they have not had a mammogram during the past\ntwo years. This year the First Lady's campaign focuses on encouraging women with\nparticularly low mammography utilization rates to get mammograms.\nImproved Mammography Quality Standards. The final regulations the President\nannounced today strengthen and improve the program the FDA implemented for\nmammography standards in 1994 to ensure that they meet standards for equipment,\npersonnel, record-keeping, and quality control. Women and their families can look for\nthe FDA certificate as evidence that the facility meets quality standards. These new\nstandards will ensure women high quality, accurate mammograms. Women can find a\ncertified mammography facility by calling 1-800-4-CANCER.\nSupported Legislation That Prevents Women From Being Forced Out of the\nHospital Only Hours After a Mastectomy. In his State of the Union Address, President\nClinton endorsed bipartisan legislation to ensure that women are not forced out of the\nhospital before they are ready because of pressure from their health plan. The\nDepartment of Health and Human Services also sent a letter to all Medicare managed care\nplans making it clear that they may not set ceilings for inpatient hospital treatment or set\nrequirements for outpatient treatment, and that a woman and her doctor should make\ndecisions about what is medically necessary.\nProvided Screening for Low-Income Women. CDC's National Breast Cervical Cancer\nEarly Detection Program offers free or low-cost mammography screening to low-income\nelderly and minority women. On October 1, 1996, Secretary Shalala announced the\nexpansion of the program to all fifty states. The goal is to reduce breast cancer deaths\namong these women by 30% and cervical cancer deaths by 90% through increased\nmammography and pap testing.\nApplied Space Technology to Detect and Treat Breast Cancer. NASA is applying\ncutting edge technology to improve ways to diagnose and treat breast cancer. For\nexample, NASA uses the microgravity of space to grow human tissue for research and\ntransplantation, gaining valuable knowledge important to the treatment of breast and\novarian cancer. Mars Pathfinder technology has been developed to enhance pictures is\nbeing modified to make three-dimensional models of breast tissue. This enables doctors\nto differentiate breast tissue more accurately without using painful invasive procedures.\nQUOTES SUPPORTING THE PRESIDENT'S INITIATIVES ON BREAST CANCER\n\"Thank you for your continuing commitment to eradicating breast cancer. Over the past five\nyears, your Administration has helped make finding the cause of and a cure for breast cancer a\nnational priority by increasing research efforts and improving current breast cancer policy.\"\n\"We applaud the Administration's dedication to improving breast cancer screening and the\npromulgation of the final regulations implementing the Mammography Quality Standard Act\n(MQSA). This Rule will ensure that every woman in America will receive the highest quality\nmammography.\"\n--National Breast Cancer Coalition\n\"The American Cancer Society (ACS) applauds President Clinton for his leadership on breast\ncancer issues. ACS supports the issuance of the final regulation of the Mammography Quality\nAssurance Standards Act (MQSA) because it will give women more confidence in the quality of\ntheir mammography.\"\n\" ACS also supports the investment in screening programs to reach poor and underserved women\nwho may not otherwise receive health care.\"\n\" Finally, ACS supports the National Cancer Institute initiative to educate women about the need\nfor annual mammograms beginning at age forty.\"\n--American Cancer Society\n\"On behalf of the National Alliance of Breast Cancer Organizations' 375 member organizations\nand the many thousands of women under their care, please accept our appreciation for your\nleadership in the fight against breast cancer. With new plans and initiatives and through support\nof federal programs and legislation, all American families have felt your concern about this most\ncommon form of cancer in women in our country.\"\n\"With your guidance, millions of women are now hearing lifesaving messages, and poor and\nunderserved women are linked to health care services they require and deserve.\"\n--National Alliance of Breast Cancer Organizations\n\"I am pleased to join millions of other Americans in applauding your leadership in all areas of\nwomen's health, especially breast cancer detection and treatment.\"\n\"Your initiatives to broaden access to mammography for all American women and to ensure that\nmammograms are done only by trained personnel at properly equipped facilities will\nundoubtedly save many lives.\"\n\" We also applaud your efforts to increase funding for breast cancer research.\"\n--Society for the Advancement of Women's Health Research\n\"The American College of Radiology (ACR) today strongly supported the Administration's far-\nreaching efforts to bring high quality screening mammography to under-served women across the\nnation.\"\n\"As a result of this private/public partnership with the ACR accreditation program and FDA\ncertification women can be assured of getting the best mammography available, which can save\ntheir lives through early detection.\"\n--American College of Radiology\n\"The American Medical Women's Association applauds the efforts of the Clinton\nAdministration in the area of breast cancer research, education, detection, diagnosis, and\ntreatment.\"\n\"As a long-time advocates for women's health, President and Mrs. Clinton are to be commended\nfor their support of the FDA's Mammography Quality Standards Act, which ensures that all\nmammography facilities in the United States are certified by the FDA as providing quality\nmammography in order to lawfully continue to provide mammography services.\"\n--American Medical Women's Association\n\"I want to commend you for your leadership of a national effort to combat breast cancer.\"\n\"The efforts of your Administration to expand Medicare coverage of mammograms are critical if\nelderly women are to take advantage of this important screening tool. Of equal significance is\nmaking women aware of the need for mammograms and that coverage is available.\"\n--American College of Obstetricians and Gynecologists\n\"Shaklee applauds the efforts of Hillary Clinton and the Clinton Administration to change\nMedicare guidelines to allow women over 50 access to annual mammogram testing.\"\n--Shaklee Corporation\n496- 3934\nTHE WHITE HOUSE\nWASHINGTON\nRADIO ADDRESS ON BREAST CANCER AWARENESS AND\nTHE MAMMOGRAPHY INITIATIVE\nDATE:\nFriday, October 24, 1997\nTIME:\n4:30 PM 9 5:00 PM\nLOCATION: Oval Office\nFROM:\nMaria Echaveste\nAudrey Tayse Haynes\nBarbara Woolley\nBrenda Anders\nL\nPURPOSE\nIn conjunction with National Breast Cancer Awareness Month, you will announce new\nregulations that will dramatically improve the quality of mammography screening and will\nlaunch an unprecedented mammography education campaign by the National Cancer\nInstitute. The First Lady will launch her annual Medicare mammography campaign to\nencourage older women to get regular mammograms. Ai this event, the First Lady and\nSecretary Shalala will also introduce two new Public Service Announcements that are\nbeing released to encourage older women to get mammograms.\nII.\nBACKGROUND\nOctober is National Breast Cancer Awareness Month and the 27th anniversary of the\nNational Cancer Act. You will be making two announcements today: 1) releasing the final\nregulations for the Mammography Quality Standards Act (MQSA) which will assure that\nwomen are receiving quality mammograms by trained medical personnel at properly\nequipped facilities, and will require patients to be fully informed of results so that follow\nup testing and treatment can begin; and 2) a mammography campaign by NCI to educate\nwomen and health providers about mammograms and breast cancer. The materials being\nreleased today were developed by NCI after they recommended that women in their 40's\nand older should get regular screening mammograms.\nYou will also amplify your strong record on fighting breast cancer including, doubling\nfunding for breast cancer research, prevention, and treatment, including $30 million in\nfunding for research into the genetic basis of breast cancer; eliminating the deductible for\nthe Medicare mammography benefit; and expanding Medicare coverage to all women ages\n49 and older making this benefit consistent with recommendations from the National\nCancer Institute (NCI).\nThe First Lady will launch her annual Medicare mammography campaign. This year\nHCFA has focused their campaign on reaching minority Medicare beneficiaries who are\nILL\nPARTICIPANTS\n4:15 PM - Pre-Brief in Oval Office:\nSecretary Shalala, Maria Echaveste, Audrey Tayse Haynes, Ann Lewis, Jordan\nTamagni, Brenda Anders and Barbara Woolley.\nFROM:WOMENS\nOFFICE\nd02-456-7311\nPH':5\n:00\nRadio Address audience of 60 people including (list attached):\nBreast cancer survivors and advocates from NBCC, NABCO, Susan G. Komen\nFoundation, and other advocacy groups;\nRepresentatives from health care organizations and providers;\nScience and technology representatives;\nCorporate representatives;\nSeveral persons featured in the new PSA's with the First Lady; and\nPersonal friends and White House staff\nIV.\nSEQUENCE OF EVENTS\nBriefing.\nMrs. Clinton makes brief welcoming remarks.\nYou and Mrs. Clinton tape radio address.\nGreet guests.\nV.\nPRESS PLAN\nWhite House photos only. The ABC, CNN, AP, C-SPAN, CBS, NBC, Mutual, UPL,\nUSA, American Urban Radio Network, and Standard News radio networks will carry the\naddress live to the collective thousands of stations across the country on Saturday at 10:06\nAM ET.\nVI.\nREMARKS\nPrepared by speech writers\nVII. ATTACHMENTS\nList of participants.\nList of National and Corporate Commitments for the National Mammography Campaign.\nList of Women Editors' Commitments for the National Mammography Campaign.\nTranscripts of three PSA's featuring the First Lady, and the First Lady's remarks in the\nPSA's.\nOutras walcs FRUITWOMENS OFFICE\nPRINE\nElisa Millsap\n10/23/97 08:26:15 PM\nRecord Type: Record\nTo:\nSee the distribution list at the bottom of this message\nCC:\nSubject: MEMBERS ATTENDING RADIO ADDRESS\n**I'll send a final list tomorrow morning.\nCONFIRMED TO ATTEND:\nSen. Feinstein\nSen. Moseley-Braun\nPENDING:\nSen. D'Amato\nSen. Barbara Boxer\nRep. Lowey\nRep. DeLauro\nRep. Slaughter\nRep. Roukema\nRep. Bilirakis\nRep. Pelosi\nMessage Sent\nTo:\nRebecca A. Cameron/WHO/EOP\nSondra L. Seba/WHO/EOP\nSarah A. Bianchi/OPD/EOP\nChristopher C. Jennings/OPD/EOP\nJennifer M. Palmieri/WHO/EOP\nSENT BY:Xenox Telecopier 7020 3-45-17\n5018271218-\n9-120245635571=\nMQSA Final Reg.*\nDraft Press Release\nFDA ISSUES FINAL STANDARDS FOR MAMMOGRAPHY FACILITIES\nAs part of Breast Cancer Awareness Month, the Food and Drug Administration today\nannounced final regulations that significantly improve the quality and performance of equipment\nand personnel at all mammography facilities in the United States. The rules expand and\nstrengthen interim regulations in effect since 1994.\n\"High quality mammograms are essential for early detection of breast cancer,\" said Health\nand Human Services Secretary Donna E. Shalala. \"FDA's mammography quality program\nassures women that their mammograms will be done by trained medical personnel at properly\nequipped facilities and that the resulting images will be of the best possible quality. Our final\nregulations will help assure that high quality standards will be a reality at virtually all facilities that\nperform mammography in this country.\"\nThe final regulations implement the Mammography Quality Standards Act (M\nQSA) passed by Congress in 1992 because of concern that not all women were receiving high\nquality mammography services and worry that breast cancer was being missed in some women.\nMQSA requires that all mammography facilities in the United States meet certain stringent\nquality standards, be accredited by an FDA-approved accreditation body, and be inspected\nannually.\nSENT BY:Xerox Telecopier 7020\n5016271213-\nS-120245385571#\nOver the past three years, the quality of mammography has improved dramatically.\nAlmost all of the nation's 10,000 mammography facilities have been inspected and accredited.\nPrior to 1992, only about 46 percent of facilities were accredited and many facilities were never\ninspected.\nThe regulations require that personnel who perform mammography be adequately trained\nand qualified to conduct mammography examinations and interpret results; that mammography\nequipment have appropriate design and performance characteristics; and that doctors and patients\nbe quickly and fully informed of results SO that any follow-up testing or treatment can begin\nimmediately.\nThe final rules toughen the standards for personnel, equipment, quality assurance and\nquality control, patient notification of results, and accreditation body performance. For example,\nphysicians who interpret mammograms must now have 60 hours training in mammography,\ntechnologists must keep their skills current by doing an average of 200 mammograms every two\nyears, and medical physicists who survey mammography equipment and facilities must meet initial\nand ongoing training requirements.\nThe regulations better define equipment capabilities needed for high quality\nmammography. They spell out requirements for mammography equipment, including for motion\nof the tube-image receptor assembly, image receptor sizes, beam limitation and light fields,\nmagnification, focal spot selection, compression, technical factor selection and display, automatic\nexposure control, x-ray film, lightening, and film masking devices.\nThe final rules also require more quality control of mobile mammography units and set\nnew standards for imaging breast implants. They also require that each facility have a consumer\ncomplaint mechanism. In addition, the rules make it clear that original mammograms must be\nSENT BY:Xerox Telecopier 7020 ; 3-45-17 1:55AM\n30162712184\n9+12024565557:*\nmade available to other medical facilities at the patient's request. This last change is expected to\nend the difficulty many women experienced under the interim regulations obtaining previous\noriginal mammograms for comparison with new mammograms, an essential aid to diagnosis.\nThe new regulations balance cost with the need for mammography to be accessible; they\nalso balance achieve ability and flexibility\nAnnual inspections to date show that overall the nation's mammography facilities have a\nvery good record of complying with standards. The first year's inspections in 1996 showed that\n80 percent of the facilities had either no violations or minor ones, and that only two percent had\nviolations serious enough to warrant a warning letter from the FDA. The second year's\ninspections have shown further improvement. So far, less than one percent of facilities have been\nfound to have serious problem.\nThe names and locations of accredited facilities are available to calling the Cancer\nInformation Service at 1-800 4-CANCER (1-800-422-6237). They are also available on the\ninternet on FDA's home page at www.fda.gov/cdrh/dmqrp.html.\nAll accredited facilities receive a certificate from the FDA which they must prominently\ndisplay stating that they are certified to perform mammography.\n###\neasy # answer\ntrialp see what\nopen\nwhat it is.\nevery undividual\nother insurance\nwouldn't 80 on\nMedicare pay ment\naccured\nhow many\n1\nwhen don't P\n3rd paty\ntrials Medicare\nL\nsafe to say all,\nsome many / 60-100 clinical prostate\ntricel would\nnot\nMedicare\neligible.\nSnidelines\n10/22/97 WED 17:10 FAX 2026905673\nDHHS/ASPA\n0002\nBackground on Mammography Bill\nS. 537 (Senator Barbara Mikulski) and H.R. 1289 (Representatives Nancy Johnson and\nEleanor Holmes Norton) reauthorize the Mammography Quality Standards Act (MQSA)\nof 1992 for another five years, through FY 2002. MQSA established national quality\nstandards for mammography and requires that all mammography facilities be accredited\nby an approved accreditation body, and certified by FDA. The bills also make a\nnumber of technical changes to the Act. Highlights of these changes will:\nensure patients and referring physicians be advised of any mammography facility\ndeficiencies.\nensure women have the right to obtain the original of their mammogram upon request\nfor transfer to another medical facility or physician.\nclarify that inspection authority may be delegated to local as well as state agencies\n(this technical change recognizes that some inspections are now being performed by\ncounty or municipal authorities, such as the city of New York).\nFor the most part, S. 537 and H.R. 1289 are consistent with the final regulations;\nhowever, there is an unresolved question on requirements for patient notification of\nresults. The final regulations require that facilities establish a system to ensure the\ncommunication of mammography results to the patient (could be oral, written, through\nreferring physicians, or a combination of all three). There is some interest in amending\nthe statute in S. 537 to require facilities to provide a written lay summary of\nmammography results directly to the patient.\nStatus:\nSenator Mikulski may try to bring it to the floor either this week or next week. There is\nno movement, as of yet, on the House side.\nNASA\nSPAC 1 CHNOLOGY USED TO DETECT AND TR AT BREAST CANCER\nNASA research and technology is revolutionizing American lifestyles in many ways, including improving ways to diagnose and treat breast\ncancer. NASA. lesming with industry, academia, and government, is applying aerospace research and technology to battle the leading cause of\ndeath among American women ages 35 to so.\nFACTS\nIN YOUR DOCTOR'S OFFICE TODAY\nDigital Breast Imaging Technology\nFrom NASA's investigations into the mysteries of the universe comes technology to better detect breast cancer. Silicon chips used in the Hubble\nSpace Telescope were adapted so doctors can easily detect tiny spots in breast tissue and analyze the tissue using a needle rather than subject a\npatient to painful surgery. This procedure also eliminates scarring or disfigurement, requires half the time of traditional techniques, reduces exposure\nto x-rays, and reduces cost from $3,500 to $850.\nTOMORROW'S TECHNOLOGY\nNext-Generation Digital Imaging Memmography\nSpace-based instruments studying the atmosphere will soon be In the medical examination room. NASA is developing a mammogram to produce\n40 Image of the entire breast and provide è better image - two times better than currently evailable - to identify tumors. Current technology\ndoes not allow doctors to view the entire breast. This approach also is significant because it will accommodate different tissue density, which is\nparticularly important for younger women who have more dense tissue.\nTelemammography\nNASA expertise in transmitting high-resolution digitized photographs has led to improvements in global satellite networks. Soon, women in I\nareas will have d link to medical experts dcross the country using these networks. This new technology will be more cost-effective and Faster than\ntraditional transmission d dsis through telephone lines, which can take hours to transmit one image. High-resclution manmography also will help\ndoctors detect breast cancer tumors earlier.\nThesue Growth in the NASA Biorgacior\nNASA uses the microgravity of space to grow human tissue for research and transplantation and to gain valuable knowledge Important to\nthe treatment of breast and overlan cancer. The NASA designed Bioreactor Is . unique tissue culture chamber that grows cells in three\ndimensions. These tissues, similar to tissues found in the body, will help scientists understand cancer growth and how the human immune\nsystem responds.\nAdvanced Ultresound Technology\nMars Pathfinder technology developed to enhance pictures is being modified to make three-dimensional models of breast tissue. Combining\nultrasound with advanced computing, the imaging device discerns cancerous from healthy tissue by comparing changes in shape and and-\nlyzing the ultrasound signal. This enables doctors to differentiate the tissue more accurately without using painful invasive procedures.\nSmart Robot Brain Surgeon Probe Adopted for Cancer Detection\nTechnology being developed for surgery on astronauts in space is being adapted to help physicians operate on delicate parts of the human body\nand minimize harm to healthy tissue. The robot maps the physical characteristics of the brain, allowing the surgeon to make precise movements and\nreduce potential damage to nearby healthy tissue. Researchers plan to teach the robot to feel and see tumors in other parts of the body, such as\nthe breast. One component includes a small probe that may allow real-time measurement and analysis of a breast cancer tumor to determine its\nseverity and appropriate treatment.\nHASA'S SPACE TECHNOLOGY PROMISES A HEALTHIER TOMORROW FOR WOMEN\nWomen's Outresch Initiative Office of Public Affairs National Aeronautics and Space Administration October 1997\nNASAFacts\nNASA\nNational Aeronautics and\nSpace Administration\nWashington, D.C. 20546\n(202) 358-1600\nTerri Hudkins\nFor Release\nHeadquarters, Washington, DC\nOctober 23, 1997\n(Phone: 202/358-1977)\nSPACE TECHNOLOGY USED TO DETECT AND TREAT BREAST CANCER\nNASA today announced how its research and technology is revolutionizing American\nlifestyles in many ways, including the diagnosis and treatment of breast cancer. Teaming\nwith industry, academia and government, NASA joins the front lines in the battle against\nthe disease and continues its October campaign for Breast Cancer Awareness Month.\n\"As a husband, father of two daughters, and a grandfather, few subjects are as\nimportant to me as women's health,\" sald NASA Administrator Daniel S. Goldin. \"That is\nwhy I am so proud of how NASA technologies, originally developed for our space and\naeronautics programs, improve health care for women, men and children around the\nworld.\"\nBreast cancer is the leading cause of death of women ages 35 to 50 in the United\nStates. More than half a million women undergo breast biopsies In the U.S. each year.\n\"The statistics of breast cancer are startling. Thanks to NASA technology, doctors are\nusing a more sensitive and efficient diagnostic tool and a less painful, less traumatic\nprocedure,\" said Administrator Goldin. \"Looking to the future, NASA will continue to\nsearch for more ways to use technology for breast cancer diagnosis and treatment.\"\nIn addition to exploring space and developing aeronautics, NASA is charged with\napplying its technology to Improve the quality of life.\n\"Our visionary researchers and entrepreneurs have made giant leaps in applying\ntechnology to medical uses. Who would have dreamed that we could map breast tissue by\nusing the same technology for mapping distant stars?\" he concluded.\nSeveral NASA biomedical experiments have resulted In successful new technology\nprograms between NASA, the National Institutes of Health, the National Cancer Institute\nand the U.S. Department of Health and Human Services Office on Women's Health.\n-more-\n20'd\nNASA CODE PSN\n2023584388\n10-23-1997 10:12\n-2-\nIN YOUR DOCTOR'S OFFICE TODAY\nDigital Breast Imaging Technology\nFrom research Into the mysterles of the universe comes a technology to better detect\nbreast cancer. Sillcon chips in the Hubble Space Telescope that convert a distant star's\nlight directly into digital Images have been adapted so doctors can easily detect tiny spots\nin breast tissue. Locating the exact spot allows doctors to analyze the tissue using a\nneedle rather than by traditional surgery. This procedure is less painful and less traumatic\nfor the patient and eliminates scarring or disfigurement. The new procedure requires half\nthe time of traditional techniques and reduces costs from $3500 to $850.\nThe new technology Images breast tissue more clearly and efficiently than conventional\nx-rays. Both the Hubble Telescope and mammograms require similar technology: high\nresolution to see fine details, wide dynamic range to capture in a single image structures\nspanning many levels of brightness, and low light sensitivity to shorten exposure and\nreduce x-ray dosage. The new highly sensitive Hubble-based technology is Improving\nbreast cancer detection. Scientists working with Hubble at NASA's Goddard Space Flight\nCenter, Greenbelt, MD, continue to refine and develop this technology.\nTOMORROW'S TECHNOLOGY\nNext Generation Digital Imaging Mammography\nSpace-based instruments used to study the atmosphere may soon have a place in the\nmedical examination room. This new approach is significant because it can accommodate\ndifferent tissue density. This is particularly Important for younger women, who have more\ndense tissue than older women. This new technology application is possible because\natmospheric studies and mammography both require compact, reliable, low-power\nsensors and digital computers.\nNASA Is working with the National Institutes of Health on a prototype that would create\nan Image of the entire breast with superior resolution.\nThe computer scans each part of every mammogram image and reports any suspicious\nareas. The electronic Images can then be transmitted to other experts If more opinions are\nneeded. Using the best mammogram technique currently available, tumors as small as\n0.2 mm, about the thickness of a piece of thread, have been detected. The goal of digital\nmammography is to identify clearly tumors as small as 0.1 mm. The approach of NASA's\nLangley Research Center, Hampton, VA, will be faster, safer, easler to use and save\ncountless lives.\n-more-\n20'd\nNSB 2000 NVVA\nET:01 2651-22-01\n-3-\nAdvanced Ultrasound Technology\nTechnology developed to improve the quality of plctures from Mars Pathfinder is being\nmodified to make three-dimensional models of breast tissue. The NASA effort, led by\nscientists at NASA's Ames Research Center's Computational Sciences Division, Moffett\nField, CA, combines ultrasound with advanced computing, automated learning, and high-\nresolution imaging techniques developed for space missions. Using the three-\ndimensional model, physicians will be able to differentlate between cancerous and healthy\ntissue without painful invasive procedures. The experimental system also will discern\ndifferences in tissue by comparing changes in shape and by analyzing the ultrasound\nsignal. The system will potentially Improve cancer treatment by focusing ultrasound\nsignals on cancerous tissue without destroying healthy tissue.\nSmart Robot Probe for Cancer Detection\nNASA technology being developed to perform surgery on astronauts in space is being\nadapted to help physicians operate on delicate parts of the human body, including the\nbrain and the breast. Led by the NeuroEngineering Group at NASA's Ames Research\nCenter, scientists have developed a robot that can map physical characteristics of the\nbrain, allowing the surgeon to make precise movements during surgery. The technology is\nbeing modified further to have the robot feel tumors in other parts of the body to\nseverity and appropriate treatment.\nThe density of cancerous tissue is different from healthy tissue. While a surgeon can,\nthrough experience, learn to feel the difference, the experimental robot can use a smaller,\nless invasive probe, and it can make more delicate and precise movements than a human,\nthus reducing damage to healthy tiesue and arteries.\nTelemammography\nThe most effective method for improving breast cancer survival is early detection. For\nwomen living in remote areas, access to mammography experts may be hundreds of miles\naway. Currently, the traditional transmission of data through telephone lines is slow and\ncostly; il can take hours to transmit one image. NASA technology will help provide quality\nmedical diagnosis and information services to remote areas in a faster, more cost-effective\nmanner.\nTelemammography, the electronic transmission of digitized mammograms, can connect\npatients in rural locations with medical experts across the country.\nNASA's Lewis Research Center, Cleveland, OH, working with breast cancer research\nhospitals, Including the Cleveland Clinic and the University of Virginia, is performing\ncritical research to allow new satellite networks to support telemammography.\nmore-\nWSB\n21:01\n-4-\nTissue Growth In the NASA Bloreactor\nNASA's Johnson Space Center, Houston, TX, is leading a project using the microgravity of\nspace to assemble and grow human tissue for research and transplantation.\nThe bioreactor is a special tissue culture chamber designed by NASA to grow cells in\nthree dimensions. One of the first experiments in this unique environment will allow\ncancer tissue to be assembled and grown from individual cells. The three-dimensional\ntissues are crucial to understanding cancer and how the human Immune system responds.\nThe bloreactor permits scientists to grow cells similar to tissues found in the human body.\nBy testing three-dimensional tissues for sensitivity to chemotherapy and hormonal therapy,\nresearchers gain valuable knowledge important to the treatment of breast and ovarian\ncancer.\n-end-\nEDITOR'S NOTE:\nPhoto and video resources and interview opportunities with contacts nationwide_are\nprovided below.\nStereotactic Blopsy using HST technology\nPhotos: Sterotactic Blopsy Machine\n94-HC-168 color; 94-H-180 b&w\nCharged Coupling Device\n94-HC-169 color; 94-H-183 b&w\nHubble Photos of Star Fields Using STIS\n97-HC-314 color; 97-H-314 b&w\nHubble Space Telescope in space\n94-HC-10 color: 94-H-13 b&w\nEagle Nebula Image using HST\n95-HC-631 color; 95-H-631 b&w\nVideo resources:\n\"War Against Breast Cancer\" October 1995\n\"Stereotactic\" Testimonials, Aug. 1996 TRT 3:30\nInterviews:\nSpace Telescope Science Institute:\nMr. Ray Villard\nDirector of Public Affairs\nBaltimore, MD\n410/338-4514\nSO\nNASA's Goddard Space Flight Center:\nMs. Tammy Jones\nPublic Affairs Officer\nGreenbelt, MD\n301/286-5566\nClinicians Using Technology:\nDavid Dershaw, MD\nDirector, Breast Imaging\nMemorial Sloan-Kettering Cancer Center\nNew York, NY\n212/639-7295\nDr. Wendi Berg\nDirector, Breast Imaging\nUniversity of Maryland Medical Systems\nBaltimore, MD\n410/328-1289\nFor interviews with patients:\nMs. Chris Westerman, Director of Communications\nMemorial Sloan-Kettering Cancer Center\nNew York, NY\n212/639-3627\nW. Phil Evans, MD, FACR\nMedical Director, Susan Coleman Breast Center\nBaylor University\nDallas, TX\n214/820-4775\nSteve H. Parker, MD\nMedical Director, Sally Jobe Breast Center\nDenver, CO\n303/741-1501\nLawrence W. Bassett, MD\nIrls Cantor Professor of Breast Imaging\nUniversity of California Los Angeles School of Medicine\nLos Angeles, CA\n310/206-9608\nValerie P. Jackson, MD\nJohn A. Campbell Professor of Radiology\nIndiana University School of Medicine\nIndianapolla, IN\n317/656-3919\nP.06\nNASA CODE PSN\n2023584338\n01:01\nDeveloper of CCDs for Hubble:\nAI Jenkins\nScientific Imaging Technologies, Inc. (SITe)\nBeaverton, OR\n503/644-0688\nStereotactic Blopsy Equipment Manufacturer:\nMs. Anne Smith\nLorad Division, Trex Medical Corporation\nDanbury, CT\n203/790-1188\nDigital Mammography\nPhotos:\nSAGE instruments\nVideo:\nSAGE III videofile 10/97 with 1 Interview\nInternet:\nhttp://oea.larc.nasa.gov/PAlS/Mammography.html\nInterviews:\nMike Finneran\nOffice of Public Affairs\nNASA Langley Research Center\nHampton, VA\n757/864-6121\nAdvanced Ultrasound Technology\nInternet:\nhttp://c-www.arc.nasa.gov/ic/projecte/bayes-group/superres/\nInterviews:\nPeter Cheeseman, PhD\nData Understanding Group\nComputational Sciences Division\nNASA Ames Research Center\nMoffett Fleld, CA 94035\n650/604-4946\nSmart Robot Probe for Cancer Detection\nPhotos:\nDr. Robert Mah and smart robot probe\nAC-97-0063-7 & AC-97-0063-8\nDrs. Robert Mah and Stefanie W. Jeffrey, discussing\ndevelopment of smart probe for breast cancer\nAC97-0350-2\nVideo:\nrobot probe in brain surgery AAV1563 5/29/96\nInternet:\nhttp://cwww.arc.nasa.gov/ic/projects/neuro/SMART_SYSTEM\nInterviews:\nRobert W. Mah, PhD\nNeuroEngineering Group\nNASA Ames Research Center\nMoffett Fleld, CA 94036\n650/604-6044\n2017\nNEW 9000 YOU\n51:01 2651-22-01\nStefanle S. Jeffrey, MD\nChief of Breast Surgery\nAssistant Professor\nDiv. of Surgical Oncology\nDept. of Surgery\nStanford University\nSchool of Medicine\nPalo Alto, CA 94305\n650/723-4617\nRussell J. Andrews, MD\nDepartment of Neurosurgery\nSUNY Health Science Center 650/723-4617\n750 East Adams St.\nSyracuse, NY 13210\n315/464-4470\nNASA Bioreactor and Cancer Cell Research\nPhotos:\nAstronaut working with Bioreactor\n94-HC-288\nMary Ellen Weber works with Bioreactor\n95-HC-497 color; 95-H-497 b&w\nInterviews:\nDr. Neal Pellls\nNASA Researcher\nNASA Johnson Space Center\nHouston, TX\n281/483-2357\nJeanne L. Becker, PhD\nPrincipal Investigator, Ground-Based Bioreactor Studies\nAssociate Professor\nUniversity of South Florida\nTampa, FL\n813/254-7774\nElliot M. Levine, PhD\nProfessor, Wistar Institute\nPhiladelphia, PA\n215/898-3884\nTelemammography\nPhotos:\nACTS Satellite\n93-HC-527 color; 93-H-575 b&w\nVideo:\nCleveland Clinic with 1 Interview 10/97\nInterviews:\nSally V. Harrington\nPublic Affairs Specialist\n80'd\nNSB 3000 PSYN\n2023584338\nS1:01\nNASA Lewis Research Center\nCleveland, OH\n216/433-2037\nSamuel J. Dwyer III, MD\nDepartment of Radiology\nUniversity of Virginia\nCharlottesville, VA\n804/924-5976\nKimberly A. Powell, PhD\nAssistant Staff Scientist\nThe Cleveland Clinic Foundation\nCleveland, OH\n216/445-9364\nWilliam A. Chilcote, MD\nStaff Radiologist\nThe Cleveland Clinic Foundation\nCleveland, OH\n216/444-6413\nLinda Dukes-Campbell\nNASA Lewis Research Center\nPublic Affairs Office\nCleveland, OH\n216/433-8920\n60'd\nNASA CODE PSN\n91:01 2661-08-01\nOctober 25, 1997\nContact: FDA Press Office\n(301) 443-3285\nMammography Quality Standards Act\nOverview: In October 1997, years of effort culminated in the publication of the final rules of the Mammography\nQuality Standards Act (MQSA). The final regulations toughen the requirements that first became effective in\n1994. They assure that mammograms are done only by trained medical personnel at properly equipped\nfacilities. that the resulting images are of the best possible quality, and that facilities employ skilled physicians\n10 interpret the results.\nCongress-passed the MOSA in 199210 ensure that all mammography done at the approximately 10,000\nfacilities in this country is safe and reliable. The Food and Drug Administration (FDA), the agency responsible\nfor implementing and enforcing the MQSA, set forth initial standards that mammography professionals and\nfacilities had to meet by October 1, 1994. The publication of the final rules this year builds on and-strengthens\nthose standards Standards must be met within 18 months after the publication of the final rules and all\nfacilities are inspected annually to ensure compliance.\nThe\nBreast Cancer's Tragic Toll\nBreast cancer is the second leading cause of cancer deaths in American women, following lung cancer.\nSince the early 1970s, the incidence of breast cancer has increased about 1 percent a year\nAn estimated 44,000 women will die from breast cancer in 1997, and an estimated 180,000 new cases of the\ndisease will be diagnosed.\nNearly half a million women will die of breast cancer in the 1990s. and more than one-and-a-half million\nnew cases will have been diagnosed in this decade.\nMammography: Why High Quality Is Important\nMammography, a special x-ray examination of the breast, is currently the most effective method for\ndetecting breast cancer early.\nHigh-quality mammography can find 85 to 90 percent of breast tumors in women over 50\nWidespread screening of women over 50, followed by prompt treatment when needed, can reduce cancer\ndeaths by as much as 30 percent.\nIf breast cancer is detected early, the cancer is less likely to have spread, giving a woman the best chance for\nsurvival.\nSetting a New Standard\nMammography can fail to do its job because of poor technique in taking, processing or reading the films;\ninadequate record keeping and reporting of results; and lack of effective quality assurance controls Under the\nMQSA, all mammography facilities are required to display their FDA certificate. To be certified, a facility must\nmeet quality standards for x-ray images and equipment, personnel standards, and record keeping and reporting\nrequirements.\nEvidence of problem\ninding a Certified Facility\nInformation on regional certified facilities is available from the toll-free number of the NCI's Cancer\nInformation Service at 1-800-4 CANCER\n10/22/97 WED 10:18 FAX 2026905673\nDRUS/ASPA\n21003\nOctober 25, 1997\nContact: HHS Press Office\n(202) 690-6343\nNCI Press Office (301) 496-6641\nFDA Press Office (301) 827-6242\nBREAST CANCER: NEW EFFORTS UNDERWAY\nOverview: Breast cancer is the most commonly diagnosed cancer and the second\nleading cause of cancer deaths among American women. There is no proven way to\nprevent breast cancer. so early detection through mammography and clinical breast\nexams is essential.\nFor women age 50-69, having regular mammogi ams can reduce the chance of death\nfrom breast cancer by one-third or more. Despite these numbers, 33 percent of women\nages 50=64, and 45 percent of women age 65 and older reported not receiving a\nmammogram during the past two years.\nThe Clinton Administration has responded to the significant threat posed by breast\ncancer with increased efforts in research, prevention and treatment. HHS Secretary\nDonna E. Shalala convened a conference in December 1993 10 establish a National\nAction Plan on Breast Cancer The national plan. which is being carried our today by\nthe public, private and volunteer sectors, is a kev clèment of the Administration's\ncommitment to fighting breast cancer.\nAt the same time; spending on breast cancer resear at HHS' National Institutes.of\nHealth has increased from $229 million in FY 1993 to $401 million in FY 1997, and a\nproposed budget of $408 million in FY 1998.\nIn 1995, First Lady Hillary Rodham Clinton launched a campaign urging older women\nto obtain mammograms, and, in particular. to promote use of Medicare coverage för\nmammography. Both the President and the First Lady have appeared in TV public\nservice announcements encouraging older women to get mainmography screening\nAnd this year. President Clinton proposed, and Congress adopted, the expansion of\nMedicare coverage which will help pay for annual mammograms for all Medicare\nbeneficiaries age 40 and over. This new benefit will be available starting\nJanuary 1, 1998.\nBackground: More Women Can Survive Breast Cancer\nThe lifetime risk of developing breast cancer today is one in every eight women, up from\none in every 13 women just two decades ago. Although death rates from breast cancer have\nbeen declining in recent years. breast cancer accounts for 31 percent of all cancers among\nwomen.\n2001\nApproximately 180,000 new cases of breast cancer will be diagnosed in 1997, and about\n44,000 women are expected to die from breast cancer. Epidemiologic studies estimate that\nbreast cancer will be diagnosed in 1.5 million American women in this decade and that\nbreast cancer will claim nearly half a million lives:\nDeath rates from the disease are highest among older, black, and low-income women.\nWith proper screening and treatment, however, the chances of surviving, breast cancer are\nimproving Breast cancer-mortality trends among both black and v hite women have\nimproved markedly in the United States since the 1980s. Between 1982 and 1987, breast\ncancer incidence for women increased about 4 percent per year, but recently has leveled off.\nThe death rate for women with breast cancer declined 6.3 percent between 1991 and 1995.\nThe greatest reductions in death rates were among younger women (9.3 percent) and white\nwomen (6.6 percent), with more modest reductions among African Americans (1.6 percent)\nand women age 65 and older (2.8 percent).\nDuring the most recent 5-year period, death rates among white women declined for\nall decades of age from 30 to 79 years. Among black women, rates were down for\nall decades of age from 30 to 69 years. Among both groups, the greatest\nimprovements in mortality were seen in the younger age groups. For women aged 30\nto 39 years, rates dropped about 13 percent among whites and 5 percent among\nblacks. For women aged 40 to 49 years, rates dropped 9 percent among whites and 2\npercent among blacks.\nHHS Spending On Breast Cancer\nHHS discretionary funding for breast cancer research, prevention and treatment has increased from\napproximately $274 million in FY 1993 to an estimated $513 million in FY 1997. As the Centers\nfor Disease Control and Prevention (CDC) have worked to increase access for all women to\nmammography screening and follow up services, the resources devoted to breast cancer services\nhave increased from an estimated $42 million in FY 1993, to $81 million in FY 1997. Cancer\nresearch is vital to our understanding of how to prevent, detect and treat breast cancer. The Clinton\nAdministration has invested in breast cancer research at the National Institutes of Health by\nincreasing funding from $229 million in FY 1993, to $401 million in FY 1997, and a President's\nbudget request of $408 million in FY 1998. HHS also helps provide treatment for breast cancer\nthrough the Medicare and Medicaid programs and through the Indian Health Service.\nHHS Action To Combat Breast Cancer\nUnder President Clinton, a wide array of activities are underway and new initiatives have been\nlaunched:\nNew Mammography Benefit\nPresident Clinton proposed, and Congress adopted, the expansion of Medicare coverage which will\nhelp pay for annual mammograms for all Medicare beneficiaries age 40 and over. This new benefit\nwill be available starting January 1, 1998.\n10/22/97 WED 10 19 FAX. 2026905673\nDHHS/ASPA\n0,005\nMammography Quality Standards\nCongress passed the Mammography Quality Standards Act (MQSA) in 1992 to ensure that all\nwomen have access to high quality mammography services. Under the final rules of the\nMammography Quality Standards Act (MQSA), published in October 1997, the FDA sets high\nstandards for mammography facilities and certifies those which meet the standards. The roughly\n10,000 mammography facilities nationwide accredited by the FDA must meet quality standards for\nequipment and personnel, and are inspected annually.\nThese regulations spell out the details for requiring facilities to hire capable technologists, use\nquality dedicated equipment that produces clear images, and employ skilled interpreting physicians\nto interpret the results both accurately and efficiently. The rules also require that doctors and\npatients be fully and quickly informed of results so that any follow-up testing or treatment can begin\nimmediately. The names and locations of FDA certified mammography facilities are available by\ncalling the Cancer Information Service at 1-800-4-CANCER. In addition, the FDA has included a\nlist of all FDA certified mammography facilities in the United States on its internet home page. The\naddress is http://www.fda.gov/cdrh/faclist.html.\nNational Action Plan on Breast Cancer\nHHS' Office on Women's Health is coordinating the National Action Plan on Breast Cancer. This\nfirst-ever national plan was developed in 1993 under Secretary Shalala's leadership. The Plan has\nawarded over $9 million in grants for 99 innovative research and outreach projects, with a special\nemphasis on the development of public-private partnerships targeted in the six priority areas:\nThe Information Action Council Working Group is working to improve access to\ninformation about breast cancer for consumers, scientists, and practitioners via the Internet\nand other information technologies.\nThe Etiology Working Group is focusing on efforts to expand the scope and breadth of\nbiomedical, epidemiological and behavioral research on breast cancer. The group has\nidentified four priority areas: chemicals and hormones, viruses, radiation and\nelectromagnetic fields, and lifestyle factors.\nThe National Biological Resources Banks Working Group (NAPBC) has focused on the\ndevelopment of a national mechanism and standard for obtaining and storing tissue for\nmultiple areas of breast cancer research. The NAPBC has awarded funds to establish a\nnational biological resources bank and is now conducting a survey of tissue banks\nthroughout the country to identify and determine the accessibility of all available biological\nresources.\nThe Working Group 10 Ensure Consumer Involvement has defined several specific activities\nto help ensure consumer involvement at all levels in the development of national research,\neducation, and service delivery programs related to breast cancer.\nThe Clinical Trial Accessibility Working Group has identified a series of initiatives to\naddress four types of barriers to participation in clinical trials, including barriers associated\nwith the informed consent process, patient and physician misperceptions about clinical trials,\nlack of information about the availability of trials, and cost.\n2028905073\nThe Working Group on Heredity Susceptibility is evaluating the ethical, legal and policy\nissues of individuals carrying breast cancer susceptibility genes.\nOn October 27, 1996, President Clinton launched the National Action Plan on Breast Cancer\n(NAPBC) Internet web site. The web site, developed by a public/private partnership and\ncoordinated by the Department of Health and Human Services Office on Women's Health is\ndesigned to serve as a gateway to information on breast cancer research, treatment, and prevention\nThe web site provides answers on frequently asked questions about breast cancer, as well as\ninformation on the NAPBC, breast cancer clinical trials and research, breast cancer organizations\nand advocacy groups, educational conferences, publications, and government and private resources\nThe web site address is: http://www. napbc.org.\nDiscovery of BRCAI and BRCA2 Genes for Breast Cancer\nBreast cancer research has been expanded at the National Institutes of Health. Promising news\ncame late in 1994 when a team of investigators at the University of Utah, Myriad Genetics, and the\nNational Institute of Environmental Health Sciences (NIEHS) identified a breast cancer\nsusceptibility gene (BRCA1) that may account for 5-10 percent of the breast cancers diagnosed each\nyear. The discovery of a second, entirely different breast cancer susceptibility gene, BRCA2, has\nhelped us understand even more about the genetics of breast cancer. Most recently researchers\ndiscovered a particular variant of the BRCA1 susceptibility gene in Jewish women of eastern\nEuropean descent (Ashkenazi Jews). While only 5-10 percent of all breast cancers are the result of\nan inherited anomaly, these findings hold promise for the development of new prevention and\ntreatment strategies.\nOther breast cancer research includes psychosocial research, which looks at how to enhance the\nquality of life in women with breast cancer, and the Breast Cancer Prevention Trial which is\nstudying ways in which to prevent breast cancer.\nOn October 27, 1996, President Clinton announced $30 million in new funding for research into the\ngenetic basis of breast cancer through a collaborative initiative between the Department of Defense\nand the National Institutes of Health.\nPrivacy of Medical Records and Breast Cancer\nPresident Clinton is urging Congress to enact legislation to protect the privacy of personal medical\nrecords. For example, the Administration's recommendations would establish a basic national\nstandard of protection for women who are carrying a specific genetic mutation such as those in\nbreast cancer genes BRCA1 and BRCA2. There would be clear guidance and significant incentives\nfor the appropriate use of personal information by those in the health care field, and real penalties\nfor misuse.\nGenetic Discrimination legislation\nWED 10:21 FAX 2026905673\n2007\nNational Breast and Cervical Cancer Early Detection Program\nThe CDC's National Breast and Cervical Cancer Early Detection Program offers free or low-cost\nmammography screening to uninsured, low-income, elderly, minority, and Native American women\nnationwide. The resources devoted to breast cancer screening services have increased from an\nestimated $42 million in FY 1993, to $81 million in FY 1997. The program, which has been\noperating in an increasing number of states over the past six years, has provided screening tests to\nalmost one million medically underserved women. In October, 1996, the program went nationwide,\nwith funding for all 50 states.\nBreast Cancer Among the Elderly\nThe Agency for Health Care Policy and Research (AHCPR) is currently funding a five-year Patient\nOutcomes Research Team study on the care, costs, and outcomes of early stage breast cancer. The\nstudy will examine three alternative treatments for early stage breast cancer in the elderly: modified\nradical mastectomy, breast-conserving surgery with radiotherapy, and breast-conserving surgery\nwithout radiotherapy. The project will look at quality and cost-effectiveness in these projects and\nwill develop clear recommendations for treating early stage breast cancer in the elderly.\nNew Frontiers In Breast Cancer Early Detection\nThe Department of Health and Human Services has been working with the Department of Defense,\nthe CIA, NASA, and other public and private entities to explore ways in which imaging\ntechnologies from other fields may be applied to the early detection of breast cancer. In particular,\nthe computer technologies that have been used to improve spy satellites may help improve breast\ncancer detection as well. In October, 1996, HHS awarded $1.98 million to the University of\nPennsylvania to conduct a series of clinical trials of imaging technology from the intelligence\ncommunity originally used for missile guidance and target recognition -- to improve the early\ndetection of breast cancer.\nCenters of Excellence\nOn October 1, 1996, the Department of Health and Human Services established six National\nCenters of Excellence in Women's Health to serve as national models for improving the health care\nof American women. The new Centers of Excellence program, with facilities located at academic\ninstitutions in different areas of the country, will integrate health care services, research programs,\npublic education and health care professional training.\nMammography Clinical Practice Guidelines\nRecognizing the importance of the quality of screening mammograms in the early detection of\nbreast cancer the AHCPR October 1994, veloped a Clinical Practice Guideline Quality\nDeterminants of Mammography--with separate versions for mammography providers, health care\nprofessionals, and consumers. The guidelines provide information on the roles and responsibilities\nof each health care professional involved in mammography services, as well as information and\nrecommendations for women.\n10/22/97 WED 10:21 FAX 2026905673\nDHIIS/ASPA\nEntos\nMammography for Women with Addictive and Mental Disorders\nWomen who are in need or who receive substance abuse or mental health services often lack\nappropriate primary health care, including breast cancer education, detection, and treatment\nWomen-focused substance abuse and mental health programs funded by the Substance Abuse and\nMental Health Services Administration (SAMHSA) are designed to be comprehensive, delivering\nprimary health care services to women who often are medically underserved These services\ninclude education on breast self-examination and mammography services, and counseling on risks\nfor breast cancer.\nEnvironmental Factors and Breast Cancer\nHHS' Office on Women's Health has established a Federal Interagency Coordinating Committee on\nthe Environment and Women's Health that focuses on how home, work, atmospheric pollutants,\nexogenous hormones, drugs, and other environmental factors may contribute to the risk of breast\ncancer and other disorders.\nOffice of Cancer Survivorship\nOn October 27, 1996, President Clinton unveiled the new Office of Cancer Survivorship at the\nNational Cancer Institute. Recent success of cancer prevention, early detection, and treatment\nefforts has created a new need: research into the physical, psychological, and economic well-being\nof the growing number of cancer survivors. The Office of Cancer Survivorship will support\nresearch covering the range of issues facing survivors of cancer, including long term medical and\npsychological effects; factors that predispose survivors to second malignancies; reproductive\nproblems following cancer treatment; and their unique insurance and employment issues.\n###\n10/22/97\nWFD\n10:23\nFAX\n2026905673\nLimitations of Mammography\nWhile mammography is the best screening tool available now, early detection does not\nnecessarily mean lives will be saved. Mammography may not help a woman with a small but fast\ngrowing tumor that has already spread at the time of detection. And about 50 percent of women whose\nbreast cancer is detected by mammography would not have died from the cancer even if they had waited\nuntil a lump could be felt because the tumors are slow-growing and easy to treat.\nBreasts of younger women contain many glands and ligaments that appear dense on a\nmammogram, SO it is sometimes difficult to spot tumors in their breasts. About 25 percent of breast\ntumors are missed in women in their 40s compared to 10 percent for women in their 50s.\nAlso, between 5 percent and 10 percent of mammograms are abnormal. Of those in younger women that\nare followed up with additional tests (another mammogram, fine needle aspiration, ultrasound, or\nbiopsy) most will not be cancer. Over the past 30 years, mammography has been able to detect a higher\nproportion of small tissue abnormalities called ductal carcinoma in situ (DCIS), abnormal cells confined\nto the milk ducts of the breast. Some believe these tumors are not life threatening, while others think\nthey are. Because there is so little data to support either view, the abnormalities are commonly removed\nsurgically.\nHHS is supporting a variety of research projects aimed at improving breast cancer detection.\nHHS PROGRAMS SUPPORTING MAMMOGRAPHY\nMammography Quality Standards. Under the final rules of the Mammography Quality Standards Act\n(MQSA), published October 1997, the FDA sets high standards for mammography facilities and certifies\nthose which meet the standards. The roughly 10,000 mammography facilities nationwide certified by\nthe FDA must meet quality standards for both equipment and personnel, and are inspected annually.\nMQSA regulations require facilities to hire capable technologists, use quality dedicated equipment that\nproduces clear images, and employ skilled interpreting physicians to interpret the results both accurately\nand efficiently. The rules also require that doctors and patients be fully and quickly informed of results\nso that any follow-up testing or treatment can begin immediately: Resources devoted to the MQSA\ntotal $26.4 million for FY 1997, and the proposed budget for FY 1998 is $27 million.\nThe names and locations of FDA certified mammography facilities are available by calling the Cancer\nInformation Service at 1-800-4-CANCER. In addition, the FDA has included a list of all FDA certified\nmammography facilities in the United States on its internet home page. The address is\nhttp://www.fda.gov/cdrn/faclist.html\n4\n2/97 WED 10:23 FAX 2026903673\nDHHIS/ASPA\nResearch To evelop Better Screening. New imaging technologies under development for breast\ncancer screening include magnetic resonance imaging, breast ultrasound, and breast-specific positron\nemission ography. In addition to imaging technologies, NCI-supported scientists are exploring\nmethods to detect breast cancer using simple tests of the blood, urine, or nipple aspirates, and to detect\ngenetic alterations that place women at increased risk for breast cancer.\nIn addition, HHS is working with the Department of Defense, the CIA, NASA, and other public and\nprivate entities 10 explore ways in which imaging technologies from other fields may be applied to the\nearly letection of breast cancer. In particular, the computer technologies that have been used to improve\nspy satellites may help improve breast cancer detection as well. In October, 1996, HHS awarded $1.98\nmillion to the University of Pennsylvania conduct a multi-site clinical trial of imaging techne logy\nfrom the intelligence community -- originally used for missile guidance and target recognition -- to\nimprove the early detection of breast cancer.\nMammography Clinical Practice Guidelines. Recognizing the importance of the quality of screening\nmammograms in the early detection of breast cancer, HHS' Agency for Health Care Policy and Research\ndeveloped a Clinical Practice Guideline - Quality Determinants of Mammography - with separate\nversions for mammography providers, health care professionals, and consumers. The guideline provides\ninformation on the roles and responsibilities of each health care professional involved in mammography\nservices, as well as information and recommendations for women.\nMedicare and Medicaid Coverage of Mammography Since 1991, Medicare has covered\nmammography screening for the early detection of breast cancer. For women age 40-49, Medicare\ncurrently covers one screening mammogram every two years, except for women with a high risk (for\nexample, a woman with a mother, sister or daughter who has had breast cancer), in which case annual\nmammograms are covered. For women age 50-64, annual screening mammograms are covered; and for\nwomen 65 and Ider, Medicare covers one screening mammogram every two years.\nPresident Clinton proposed, and Congress adopted, the expansion of Medicare coverage which will help\npay for annual mammograms for all Medicare beneficiaries age 40 and over. This new benefit will be\navailable starting January 1, 1998.\nUnder Medicaid, diagnostic mammograms are a mandated service and states must cover them.\nScreening mammograms, wever, are provided by states as an optional service, with most states\ncovering screening mammograms in fee-for-service Medicaid. In addition, virtually all Medicaid\nmanaged care plans offer preventive services, including mammography, to their enrollees.\nThe Health Care Financing Administration has urged states to provide annual mammography screening\nto Medicaid beneficiaries at age 40; HCFA will continue to provide federal matching payments for\nannual mammography screening services.\n5\nWED FAX 2026905673\nNational Breast and Cervical Cancer Early Detection Program. The CDC's National Breast and\nCervical Cancer Early Detection Program offers free or low-cost mammography screening to uninsured,\nlow-income, elderly, minority, and Native American women nationwide. The resources devoted to\nbreast cancer screening services are estimated to have increased from $42 million in FY 1993, to $81\nmillion in FY 1997. The program, which has been operating in an increasing number of states over the\npast six years, has provided screening tests to almost one million medically underserved women. In\nOctober, 1996, the program went nationwide, with funding for all 50 states.\nPrivacy of Mammography Records. President Clinton is urging Congress to enact legislation to\nprotect the privacy of personal medical records. These recommendations would establish a basic\nnational standard of protection for mammography records, and women whose medical records reflectiva\nspecific genetic mutation such as those in breast cancer genes BRCA1 or BRCA2. There would be clear\nguidance, and significant incentives for the fair treatment of personal information by those in the health\ncare field, and real penalties for misuse.\nMammography for Women with Addictive and Mental Health Disorders. Women who are in need\nor who receive substance abuse or mental health services often lack appropriate primary health care,\nincluding breast cancer education, detection and treatment. Women-focused substance abuse and mental\nhealth programs funded by the Substance Abuse and Mental Health Services Administration (SAMHSA)\nare designed to be comprehensive, delivering primary health care services to women who often are\nmedically underserved. These services include education on breast self-examination and mammography\nservices, and counseling on risks for breast cancer.\n###\n1992\nGAO study\n->\noutside\nwecander\nout\nInterim\nrules.\nBefore the\n1698-258\nact techinican\nFuels\nbest\nT\nequipment\ncall\nfaulty\nof\nphysican\nmade mistakes\nIES\nstatutes.\nLZ8\ntechnican\n10E\ntrained.\ncomusees.\nequipment\nMostue\ncalibrated\nbeen\nphysican trained,\nreaded\nHUMAN SERVICES USA\nDEPARTMENT OF HEALTH & HUMAN SERVICES\n2\nHEALTH\nLaurie Boeder\nOF\nDeputy Assistant Secretary for Public Affairs\nPhone: (202)690-7850\nFax: (202)690-5673\nTo:\nSarah Bianch,\nHIVERVE\nNA\nNA\nIssue\nFax: 456-5557\nPhone: 456-5585\nDate: 10/1/97\nTotal number of pages sent: 21\nComments:\nRe: HCFA Mammography materials\n-\nFact Shut\n- \"Horizons\" Summary\nPlease let me know if you have\nany questions. thanks.\n- michile\n200 Independence Avenue, S.W., Bldg. HHH, Room 647-D, Washington, D.C. 20201\nHCFA & Breast Cancer/Mammography\nI.\nNew Annual Screening Mammography Benefit Under Medicare\nNew law signed by the President on August 5, 1997, as part of the Balanced Budget Act\nof 1997 provides Medicare coverage for annual screening mammograms for all Medicare\neligible women age 40 and over, and waives the Part B deductible for screening\nmammography, effective for services provided on or after January 1, 1998.\nExplanation of prior law compared to new law:\no\nFrequency of coverage for mammography\nPrior law provided coverage of annual screening mammograms for women age 50-\n64, and those at high risk age 40-49. However, screening mammograms for\nwomen over 64, and for women at normal risk age 40-49, were covered only\nbiennially. The new law expands coverage to pay for annual screening\nmammograms for all female Medicare beneficiaries age 40 and over, for services\nprovided on or after 1/1/98. This change removes an anomaly in the prior law that\nprovided more frequent mammography for women age 50-64 than for those over\n64, even though the risk of breast cancer increases with age. It also makes\ncoverage consistent with the frequency recommendations of most major breast\ncancer authorities.\nCost-sharing for mammography services\nPrior law required beneficiaries to pay the Part B deductible (to the extent not\nalready met) and 20% coinsurance for both screening and diagnostic\nmammograms. The new law waives the deductible for screening mammograms for\nservices provided on or after 1/1/98. Beneficiaries must still pay 20% coinsurance\nfor screening mammography, and must pay both the unmet deductible and 20%\ncoinsurance for diagnostic mammography.\nII.\nPrograms Under HCFA's National Mammography Campaign\nMammography HORIZONS Project\nAs part of the HCFA HORIZONS Program: Special Partnerships for Special Populations,\na mammography project is being conducted to develop local partnerships for Hispanic\nAmerican and African American communities in six major cities - Philadelphia, Atlanta,\nCleveland, Chicago, San Antonio, and Los Angeles. Partners will work together to\nconduct locally planned interventions to increase the rates of mammography screening for\nMedicare beneficiaries in these communities. We have completed the market research\nphase, examining the knowledge, attitudes and beliefs of beneficiaries and health care\nproviders to better understand the barriers to mammography utilization in those cities.\nOne-day meetings are being held in each of the cities, including all the key stakeholders, to\nbegin planning appropriate interventions which will be conducted by the PROs in\ncollaboration with the partner organizations. The mammography HORIZONS project is a\nthree year commitment by HCFA to increase the use of Medicare mammography\nscreening services.\nPreventive Screening Services Project\n- A-collaborative project with the Centers for Disease Control and Prevention and\nMaryland's Department of Health and Mental Hygiene is being conducted to evaluate the\neffectiveness of physician referral, prompted by an office reminder system for\nmammography and papsmears utilization (as reflected in Medicare billing data) for\nMedicare African-American beneficiaries age 65 and older.\nMammography Campaign Print Materials\nHCFA tested mammography messages and visual designs on female Medicare\nbeneficiaries age 65 and over in order to provide these women with relevant,\nunderstandable printed information about the importance of regular mammograms and\nMedicare coverage available for mammograms. Based on the results of this testing we\ndesigned postcards, posters, bookmarks and stickers. The messages and graphic design\non the materials are simple and straight forward and were accepted amongst the variety of\nethnic and racial groups tested. The materials are in English and Spanish and will be\ndistributed to Medicare beneficiaries through HCFA's contractors (Peer Review\nOrganizations, Carriers, ICA Grantees, and HMOs) and various partners (health\ndepartments, breast cancer groups, beneficiary auvocacy groups, etc.).\nMammography Data Books\nHCFA has printed mammography data books for 1994-1995 Medicare mammography\nutilization rates. This data can also be retrieved off of HCFA's homepage:\nwww.hcfa.gov/stats/mamm/mammover.lhtm In addition, 1995-1996 data is being released\nin October.\nRadio Public Service Announcements\nHCFA is sending English and Spanish radio PSA scripts to radio stations nationwide that\ntarget the older population. The PSAs were designed and tested by one of HCFA's Peer\nReview Organizations.\nMedia Campaign\nHCFA is in the midst of planning a media campaign to announce the expanded screening\nmammography benefit in January or February. A possibility is to hold a one or two day\nconference on breast cancer and mammography and to invite federal agencies, breast\ncancer leaders and the press. In addition, HCFA will update its print and video materials\nto reflect the message about new coverage for annual mammograms. Finally, HCFA will\naggressively pursue print, tv and radio coverage of the benefit change.\nIII.\nInformation on Medicare and Mammograms\nThe Health Care Financing Administration (HCFA) has developed a fact sheet and an\nabstract regarding three programs related to breast health. Information about these\nprograms, the National Medicare Mammography 2000 Campaign, Preventive Screening\nServices Project, and the Mammography HORIZONS Project, can be accessed at:\nwww.hcfa.gov/medicare/hsqb/hsqb3f.ltm (abstract)\nwww.hcfa.gov/medicare/hsqb/hsqb6f.litm (fact sheet)\nMammography data can be accessed at:\nwww.hcfa.gov/stats/mamm/mammover.htm\nHCFA's Medicare Hotline (1-800-638-6833) provides information on Medicare coverage\nof mammograms.\nContact:\nHCFA Press Office at (202) 690-6145\nHORIZONS MAMMOGRAPHY MEETINGS SUMMARY\nThe Health Care Financing Administration's (HCFA) National Medicare Mammog aphy\nCampaign's goal is to reach at least a 60 percent utilization rate for Medicare-paid screening\nmammograms for all female Medicare beneficiaries 65 and older by the year 2000. HCFA intends\nto accomplish this goal in a way that assures equity participation among the diverse populations\nserved by the Medicare program which have lower than average utilization rates.\nAs part of the HCFA Horizons Program: Special Partnerships for Special Populations,\nmammography projects are being launched in six major cities with low mammography utilization\nrates to develop local partnerships in Hispanic American and/or African American communities to\nincrease these rates. The selected cities and populations are: Philadelphia- African American,\nAtlanta-African American, Cleveland-African American, Chicago-Hispanic and African American,\nSan Antonio-Hispanic, and Los Angeles-Hispanic and African American. Together with HCFA's\nRegional Offices and HCFA's contractors, the Professional Review Organizations (PRO), the\ncommunity-based partners will work together to plan and implement locally planned interventions\nto increase the rates of screening mammograms for Hispanic and African-American Medicare\nbeneficiaries in these communities. The Mammography Horizons project is a 3- year\ncommitment by HCFA to increase the use of Medicare screening mammograms.\nTo help the communities with their planning, HCFA conducted market research in each city\nexamining the knowledge, attitudes and beliefs of beneficiaries and health care providers to better\nunderstand the specific barriers to mammography utilization in those cities as well as identifying\nbreast cancer intervention programs and key stakeholders. The market research analysis was sent\nto the stakeholders who were also invited to attend meetings in each of the cities to begin\nplanning appropriate interventions to be conducted by the PROs in collaboration with the\ncommunity-based partner organizations.\nAlthough screening mammograms and outreach are provided by numerous organizations in each\ncity, local partnering has been very limited among these organizations and there have been very\nfew efforts directed at the African American or Hispanic Medicare beneficiaries. In each\ncommunity, the Horizons Mammography conferences provided a forum for participants to gain\nknowledge abo each of the participating organiza ons and programs. The opportunity to\ndevelop a shared vision to increase the utilization of screening mammograms for Hispanic and\nAfrican American Medicare beneficiaries was enthusiastically supported by virtually all of the\nparticipants. A brief description of the meetings and preliminary ideas for local interventions for\neach of the cities follows.\nCleveland, Ohio\nThe first of the six cities to hold a planning conference and \"kick off\" the Horizons\nMammography Project was held in Cleveland, Ohio, August 21, 1997. The primary goal of the\none day conference was to discuss the issues and barriers for Medicare beneficiaries and providers\nthat affect mammography use among Cleveland's over 65 year old female African American\nbeneficiaries. Participants included community and academic leaders from the Academy of\nMedicine of Cleveland, the local chapter of the American Cancer Society, the Center for Health\nAffairs, the City of Cleveland, the Cuyahoga County Board of Health, the Junior League, the\nMinority Women with Breast Cancer Uniting, WUAB-TV 43, and multiple health care providers.\nFor 1994-95 the mammography utilization rates were 37 percent for African American Medicare\nbeneficiaries in Cuyahoga County. The market analysis conducted in Cleveland elicited\ninformation about barriers to breast health for the targeted population which included:\ntransportation, child care, absence of a primary physician, lack of understanding of the Medicare\nbenefit, cost, fear of finding cancer and then, not having the financial resources to pay for\ntreatment, fear of radiation. The market research identified barriers in the provider population as:\na need for education on breast screening services; debate in Cleveland's medical community about\nthe need to acknowledge cultural and ethnic diversity and the effect on attitudes about preventive\ncare.\nA follow-up meeting between the PRO and the conference participants was held September 17 to\nbegin development of the Horizons Mammography work plan. The wor¹: plan will include\neffective interventions developed by the participants aimed at increasing utilization of the\nMedicare screening mammography benefit among Cleveland's African American female Medicare\nbeneficiaries.\nDuring the first year efforts will focus on educating beneficiaries about the Medicare screening\nmammography benefit and the importance of getting annual mammograms. Other efforts will be\ngeared to the education of physicians about the Medicare screening mammography benefit and the\nimportance of referring women 65 and over for annual screening mammograms. Also during the\nfirst year, the PRO and the community will plan additional interventions aimed at beneficiaries as\nwell as health ( re teams to be implemented during the : cond and third years.\nCurrent and year one outreach and intervention activities in Cleveland include: participation in\nhealth fairs, provision of mobile mammography units; community education; screening, detection\nand treatment support services; and information dissemination to members of professional\norganizations. Also included aΓe:\nKick-Off Events-- Receptions October 24 and 25, 1997 featuring National Spokes Person\nMiss Black USA 1996, Dawn Moss, for the Hands For America Breast and Prostate\nher\nCancer Awareness Program and Mayor Michael White; Give Me Your Hands Toget\n0\nWithout Tears Breast Cancer Survivors Quilt Exhibit (Oct. 24-31), hosted by Metr\nHealth Clements Center for Family Care\nAmerican Cancer Society breast health telethon and Tell A Friend\nDevelopment of church health ministries coalition (focus on women's health/breast health\nand awareness)\nDevelopment of breast health holiday greeting card\nProvider education seminar on Medicare mammography coverage and beneficiary\ncommunication strategies.\nBeneficiary Interventions:\nAmerican Cancer Society-Tell A Friend Program\nand Breast Health Telethon\nAcademy of Medicine's radio station (interview - message on telemed)\nAARP newsletter articles\nNationwide Insurance to include in newsletters and/or benefit statements\nDepartment of Aging newsletter - Senior Times\nDisplay posters at senior centers and meal sites\nInteractive Education al Presentations\nBells For Remembrance\nDevelopment of Church Health Ministries Coalition\nDays of Caring and Sharing\nBreast Bingo Play-Off\nACS Special Touch Training\nDesign Holiday Greeting Card with \"Breast Heath Message\"\nPartnership with Flu Shot Programs (Breast Health material Distribution)\nMedia Campaign; PSA, newspaper articles, local transit and billboard advertisement, local\ntelevision coverage; Black History Month, (Feb.) Minority Cancer Awareness Month,\n(April) Mother's Day, (May) Minority Health Month, (June) Women's Health Month,\n(September) Breast Cancer Awareness Month, (October) Planning--Nov. / Jan.\nCommunity HEALTHTalk Seminars\nSenior Health and Beauty Action Group (Queen of SHeBA Group)\nAdopt a Granny for Life-Youth to Elder; BSE Education Development and Training\nProgram\nProvider/Physician Interventions:\nAcademy of Medicine publication (bimonthly) - distributed to physicians in Cuyahoga\nCounty\nArticles in OSMA publication and Buckeye Osteopath\nHospitals to include on agenda at medical staff meetings and include in newsletters\nProfessional Conference Exhibit Displays\nDevelop City-Wide Senior Women's Wellness Initiative for Geriatric Health Professionals\nTo learn further about linkages with the community, programs and services provided, past and\nfuture collaborations, and results of breast health activities, the following organizations and\nproviders have agreed to participate in the project:\nAmerican Cancer Society\nGreater Cleveland Hospital Association\nMinority women with Breast Cancer Uniting\nUniversity Hospitals of Cleveland, Ireland Cancer Center\nEncoreplus Program, YWCA of Cleveland\nOffice of Urban and Minority Health: Case Western Reserve University\nCuyahoga County Board of Health, Breast and Cervical Cancer Project\nHough Health Center\nOlivet Institutional Baptist Church\nNE Ohio Neighborhood Health Services\nODH, Breast and Cervical Cancer Project\nBenjamin Rose Institute\nSt. Lukes Medical Center\nMetro Health Systems Clements Community Health Center\nMarymount Hospital\nIreland Cancer Center\nParma Community Hospital\nMinority Health Alliance\nThe African American Cancer Support Group\nLos Angeles, California\nThe Los Angeles Horizons Mammography Conference was held August 27-28, 1997. The\nprimary goal of the conference was to discuss the issues and barriers for Medicare beneficiaries\nand providers that affect mammography use among Los Angeles' 65 and older female African\nAmerican and Hispanic beneficiaries. Approximately 100 participants attended this conference.\nThe following organizations in attendance represent a flavor of the audience and of the work\ncurrently taking place in Los Angeles:\nCalifornia State Health Department, BCEDP who seeks to impact mortality through the\nquality of providers' training and standards and promoting screening and rescreening of\nwomen.\nCalifornia State Health Department, Breast and Cervical Cancer Control Program whose\ngoals are to influence provider training and practice, referral networks, and women\nthrough community channels.\nEncoreplus Program, Greater L.A. YWCA recruits and case manages women from\nscreening through diagnosis for breast and cervical cancer.\nMission City Community Network provides screening mammograms via a mobile van.\nWatts Health Foundation is a community-based health clinic which provides screening and\ndiagnostic mamitiograms.\nWhite Memorial Hospital Medical Center provides mammography and outreach to the\ncommunity.\nGlaxo-Welcome is a pharmaceutical company that is beginning to get more involved in\nresearch/advocacy and prevention efforts.\nRAND Mammography Promotion in Churches Program encourages mammography\nscreening, identifies barriers to screening, and evaluates the effectiveness of a church-\nbased program for promoting screening.\nThe Edward R. Roybal Institute for Applied Gerontology partners with groups that\ncultivate trust with ethnic communities to develop messages to encourage health\npromotion and care-seeking among Latinos and African-American elderly persons.\nUniversity of Southern California, Norris Comprehensive Cancer Center works on a\nmammography research project with five universities throughout the United States funded\nby the National Hispanic Leadership Initiative on Cancer.\nUrbai. Health Initiatives, Drew University IS conducting a survey on knowledge, attitudes,\nand behaviors of African-American women related to breast cancer prevention and\nemphasizes greater community involvement in defining agendas, research, and health\nadvocacy.\nWomen of Color Breast Cancer Support Project is an advocacy group which highlights\nself-esteem, empowerment, and building motivation for health awareness and health\nprevention practices.\nPartner for Progress underscores the importance of organizations in the community\nbanding together to promote mammography screening.\nCancer Information Service\nAmerican Cancer Society\nNational Black Leadership Initiative on Cancer\nThree types of sessions were the driving force of the conference. They were formal presentations,\npanel discussions, including interviews with women in African-American and Hispanic\ncommunities, and small group discussions. Dr. David Reuben, Chief, Division of Geriatrics,\nUniversity of California Los Angeles, School of Medicine discussed research-based insights on\nbarriers and how to overcome them. Dr. Mary Elina Ferris, CMRI, shared data showing\nmammography rates in California based on Medicare claims data. Dr. Sarah Fox, RAND\nCorporation shared data from Hispanic and African-American communities in Los Angeles. Jane\nCordingley-Klein, CMRI examined the marketing perspective of the Medicare population. In\naddition to the sessions the keynote speaker, Christina Sanchez-Camino, Director, Public Affairs,\nKMEX - Channel 34, shared personal experiences and insights into the effective use of Spanish-\nlanguage television to promote mammography screening in minority communities.\nThe panels discussed effective strategies and solutions to increase mammography screening in\nMedicare Hispanic and African-American women from both a patient/population perspective and\na provider/systems perspective. The small group discussions also followed this format and were\nsuccessful in highlighting the significant barriers and possible solutions for these groups. The\nfollowing issues were discussed:\nLack of health care provider sensitivity is one of the most important reasons why older\nAfrican-American and Hispanic women do not have regular mammograms. Lack of cultural\nsensitivity, distrust of the medical community, disrespect that providers display toward the patient,\nand lack of provider sensitivity in communicating with women are major perceived barriers for breast\ncancer screening among older minority women. Physicians' interpersonal and cultural styles influence\nwomen's adherence to recommended cancer screening guidelines. Physicians who answer questions\nand offer support are more likely to have satisfied patients who accept and follow clinicians\nrecommendations.\nPhysician recommendation is a major motivational factor for older women. The advice of a\ntrusted physician is a key factor for older women to get a mammogram. The overwhelming majority\nof women who have mammograms have physician referrals. Unfortunately, physicians are less\ninclined to refer women 65 and older for mammography, and even less with women 70 and older.\nHealth re providers need to be trained to be nore sensitive towards patient needs. Education\nin medical schools about cultural sensitivity and communication is essential. Interns should learn more\nabout working with the elderly. Health care providers need to explain procedures before a exam and\nbe very sensitive to the woman's feelings during the mammogram. Physicians must be a patient\nadvocate and to work with patients to gain compliance.\nLack of knowledge of the Medicare Mammography benefit among older women. Providers and\nbeneficiaries do not clearly understand the Medicare Mammography benefit. A large proportion of\nolder women are not aware of the Medicare mammography benefit for women 65 and over. Some\nare unsure about the co-payment percentage amount and the beneficiary eligibility requirements for\nPart B.\nCultural attitudes and values discourage the use of mammography among older women.\nFear - Fear of pain and disfigurement associated with treatment. \"Too old\"- Some women believe\nthey are too old for mammograms or breast cancer. There is the notion that if women are post-\nmenopausal or not sexually active, they are less likely to get breast cancer. Embarrassment -\nWomen are not comfortable in touching or having breasts touched. Resignation - Having breast\ncancer is equated with death. \"It is in the hands of God\" or \"What is meant to happen, will happen.\"\nMistrust of the health care system is very pronounced. Lack of preventive attitude - Some women\ntend to get health care only when they have developed clinical symptoms. Low vulnerability to\ncancer. Perception of cancer risk is low because there are no symptoms of breast cancer.\nMedia campaigns should combat negative attitudes toward breast cancer screening and\nmisperceptions including: a) risk for breast cancer decreases after childbearing years, b) risk is\nrelated to sexual activity, c) discovering breast cancer is a fearful experience, d) great pain must be\nendured during screening procedure, and e) funds are not available to pay for treatment. Personal\ntestimonials influence women who are resistant and the message is very powerful coming from a\ncancer survivor.\nOlder women reported major structural barriers to breast cancer screening: Transportation\nand lack of social support (how to get there, someone to take them) are major problems. Child\ncare - Older women are the traditional care givers in families and many are assisting in raising their\ngrandchildren. Language is a barrier. Language is a problem in the Hispanic population as well as in\nthe African American community. Time - Not having enough time. Time away from work. Cost -\nThe cost of screening mammograms is a significant barrier to beneficiaries. Women live on fixed\nincomes. Household requirements are more important than mammograms.\nOlder women do not understand the health care system and feel \"out of place.\" There\nare too many steps and layers in the system. Women want to make \"one\" call to get\nassistance and \"One-stop\" comprehensive services.\nOutreach and media campaign efforts should be focused on informing the public about\nMedicare mammography guidelines, coverage and use. There is a need to develop a public\ninformation campaign to inform older women and health care providers of the new annual Medicare\nmammograph benefit and about the benefits of : ammograms. Electronic media such as\ntelevision and radio are major vehicles for health information.\nEffective mammography screening interventions need to use multiple strategies to reach\nelderly women. Effective outreach should also target populations outside the medical settings\ninclude beauty shops, churches, and schools. Interventions should consider non-English speaking\npopulations, high risk populations, and underserved populations.\nCommunication messages that promote the use of annual mammograms must use\nsegmentation and be culturally sensitive. Communication messages need to be tailored to the\nspecific needs of the target group (e.g., images need to look like women being targeted). Education\nmaterials must use appropriate images, address literacy level, use simple language, and have big print\nfor ages 65 and older.\nThere is a strong need to participate with national, State, regional community groups in the\npromotion of breast cancer screening for elderly women. Effective partnerships include working\ntogether with health care organizations such as California Medical Review, Inc. (CMRI), Health Care\nFinancing Administration (HCFA), Roybal Institute for Applied Gerontology; cancer programs such\nas Breast Cancer Early Detection Program, Cancer Information Service, the American Cancer\nSociety; cancer coalitions such as the National Black Leadership Initiative on Cancer, Partnered for\nProgress, National Hispanic Leadership Initiative on Cancer; and academic institutions such as the\nUniversity of California, Los Angeles, Drew Medical University, University of Southern California\nand any other breast cancer community organizations.\nThe California Peer Review Organization in partnership with the community is planning an\neducational campaign to inform women and health care providers about the importance of\nmammograms for older women in Los Angeles County. In collaboration with national, State,\nregional and community groups in order to improve routine screening mammograms among Los\nAngeles county Medicare beneficiaries with a special focus on specific areas of the Los Angeles\nCounty covering 10 percent of California's female Medicare beneficiaries where mammography\nrates are lowest and African American and Hispanic/Latino beneficiaries reside. The campaign\nefforts will:\ntarget physicians and health care providers to advise older women about the importance and\nvalue of early cancer detection and referral to cancer screening services.\ndevelop and disseminate public information and culturally sensitive education materials related\nto the detection and control of breast cancer to increase knowledge of and positive attitudes\ntoward mammography and reduce fear associated with cancer detection among California\nMedicare-enrolled women.\nwork in partnership with community groups combining complimentary efforts.\nA supportive mass media campaign will include radio and television Public Service\nAnnouncements, newspaper articles and press releases explaining the new Medicare benefit and\nthe importance of mammography. Attractive educational materials will be developed. Messages\nand materials will be crafted with the specific target populations in mind, paying particular\nattention to cultural differences. The campaign logo his been wi, cly accepted among African\nAmerican and Hispanic women: \"Get a mammogram every year. Do it for yourself. Do it for your\nfamily.\"\nPhiladelphia, Pennsylvania\nApproximately 120 person were in attendance at the Horizons Mammography conference on\nSeptember 4, 1997. The target audience for the Philadelphia project is African-American\nMedicare eligible women age 65 and older. The one day conference focused on the barriers to and\nthe possible interventions for increasing the rate of mammography screening by this population.\nAttendees included individuals local provider and beneficiary groups and organizations.\nThe conference agenda consisted of presentations on the National Medicare Mammography\nCampaign, the background for the Horizons Mammography Project and the market analysis\nconducted in Philadelphia. The honorable Marion Tasco, Ninth District Councilwoman addressed\nthe participants on the need for community partnerships and shared her enthusiasm and support\nfor the project. Breakout groups were held later in the day and were divided by the following\ntopic areas: Physician/Provider Interventions, Social/Recreational Interventions, Religious Setting\nInterventions and Business Affiliated Interventions. Each of the groups discussed interventions\nthat could be used in the various settings and ways that they might go about implementing those\ninterventions.\nMedicare Part B claims data reveal that only 40 percent of African-American women age 65 and\nolder in Philadelphia, PA received a mammogram in 1995. The market analysis in Philadelphia\nrevealed the following barriers perceived to be reasons for low mammography rates among\nAfrican American women age 65 and over:\nLack of Awareness - there appears to be a significant amount of lack of awareness about the\nneed for annual screening mammograms and the potential for successful treatment of breast\ncancer.\nFear - the most visceral fear for the target population is discovering that they have breast cancer.\nOther fears include fear of pain associated with the mammography screening procedure, not\nknowing what to do if breast cancer is diagnosed, fear of disfigurement, and a fear that African-\nAmericans are more likely to be experimented upon.\nCost - more 'ducation fro beneficiaries and providers is needed about the Medicare-paid\nmammography screening benefit. Cost related to transportation is also a concern.\nCultural Attitudes - an attitude that presents a major barrier is a kind of \"fatalism\" which leads\nwomen to say that \"the Lord will take care of me\" or \"what's meant to be is meant to be.\" There\nis also a tradition that family comes first and therefore older women with low incomes will not\nspend money on themselves for preventive care.\nTransportation - although older Philadelphians can ride public transportation at reduced rates,\nthis is possible only during non-rush hours. Some participants stated that transportation can be an\nissue because of cost, convenience, or perceptions of safety.\nE\nThe major stakeholders in Philadelphia include:\nPRO - Keystone Peer Review Organization\nHMOs and Health Systems- Aetna/US Healthcare, Allegheny Health Systems, Mercy\nHealth Systems, North Philadelphia Health System, Qualmed, Spectrum Health Services\nBreast Health and Cancer Organizations - Breast Health Institute, Cancer Information\nService, Linda Creed Breast Cancer Foundation, Living Beyond Breast Cancer\nSororities - Delta Sigma Theta Society, Lambda Kappa Mu Sorority\nUniversities - Lincoln University, Temple University, University of Pennsylvania (Cancer\nControl, Research, Nursing and Radiology areas), Villanova University\nHospitals and Nursing Centers - Germantown Hospital, LaSalle Nursing Center,\nState and Local Government - Philadelphia Department of Health, Pennsylvania\nDepartment of Health, Pennsylvania Department of Aging, Philadelphia Corporation for\nAging, Philadelphia Department of Public Health, Mayors Commission to Services to the\nAging, City Councilperson Marian Tasco\nAfrican-American Organizations - Black History Month Committee, National Black\nWomen's Health Project\nConsumer/Women's Organizations - Family Planning Council, Urban League of\nPhiladelphia, The Health Federation of Philadelphia\nHealth Centers - Strawberry Mansion Health Center, Chestnut Hill Health Care\nWomen's Center\nReligious Organizations - Women of Faith and Hope\nCurrent Outreach Activities already occurring in Philadelphia include:\nAvailability of reduced rates for public transportation during non-rush hours\nMobile mammography van operated by the City of Philadelphia Department of Public\nHealth\nFree educational and prevention activities occur through numerous organization (e.g.,\nmedical center, American Cancer Society)\nAvailability of two comprehensive cancer centers (Fox Chase Cancer Center & University\nof Pennsylvania)\nNum rous mammography screening center (L' dr Creed Breast Cancer Foundation,\nPhiladelphia Corporation on Aging, etc.)\nBreast cancer hotlines\nInvolvement of several African-American radio stations (WDAS, WHAT) & newspapers\n(Philadelphia Tribune) as well as African-American churches\nCircle of Friends activities -- small groups working together to discuss this taboo topic,\nencourage women to obtain mammograms, etc.\nAt the Philadelphia Horizons Mammography Conference the following two interventions were\nsuggested:\nBusiness Affiliated Interventions: Involve businesses within individual neighborhoods in\nbuilding sustainable local coalitions to encourage neighborhood residents to use the screening\nmammography benefit; develop partnerships with large employers to spread the word, through\nemployee newsletters, to family members; work with utility companies to advertise messages, use\nsimple methods (colored \"referral\" slips provided by local businesses to track what influenced\nwomen to obtain mammograms).\nReligious Interventions: Begin working with mosques, pastors, and their health ministries\n(including pastor's wives and church nurses) by involving them in the development and planning\nprocesses; gather better information as to availability of public transportation (what organizations\noffer it, phone #'s, working hours, pick-up/drop-off locations, etc.); develop listing of\norganizations/ways to cover the 20 percent of the cost not paid for by Medicare; work with the\nlocal media; develop one consolidated set of campaign materials supported by all multi-city\nparticipants (including names of all organizations) and try to include some sort of scripture\nreference (body is a temple, etc).\nAtlanta, Georgia\nThe Atlanta Horizons Mammography Conference was held September 9, 1997. Approximately\n100 participants attended this conference to discuss how to overcome barriers to mammography\nuse by African American Medicare beneficiaries. According to conference participants who were\nrepresentatives of community-based organizations, faith institutions, academic institutions,\nphysicians and mammography providers, and other individuals/agencies who work with older\nAfrican American women, the major barriers to routine mammography screening among this\ntarget group are the following:\nolder African American women do not perceive themselves to be susceptible to breast\ncancer\nfears related to having a mammogram and the possibility of detecting cancer\nlack of awareness about the importance of routine mammography for women 65and over\nlack of access to the facility and transportation\nlack of physician referral for mammogram\nlack of, or under use of, trusted individuals to convey importance of annual mammograms\nto African American women 65 and over\ncost and variable reimbursement\nlack of data and clear guidelines about mammography for women 70 and over\ncultural attitudes and religious beliefs\ncompeting concerns\ninconvenience\nco-morbid illnesses\ncultural-communication barriers between physicians/providers and the women\nlack of feedback for physicians on comparative performance\nThe metropolitan Atlanta community has many strengths in the diverse groups of organizations\nthat are working to reach older African American women with health-related information.\nChurches and community-based organizations, including such groups as the American Cancer\nSociety, NBLIC, Reaching Out to Senior Adults (ROSA) etc., are engaged in various projects\nspecifically designed to reach African American women on mammography. Current outreach\nactivities in Atlan: 1 include:\nOlder Women's League- Fifteen metro women are conducting workshops in the community at\nsenior high-rises and senior centers stressing the importance of BSE, mammography, and clinical\nbreast exams.\nEast West Breast Express-the outreach program reached 2,029 women 16 Marta Stations\n(Atlanta's Rapid Transit System) about the importance of mammography. They did clinical breast\nexams and gave away coupons for marumograms.\nBreast Health Education Study- Morehouse College presented a two pronged program. They\nworked with public housing and also presented a play \"Nightmare\" to physicians. The play was\nabout a doctor that forgot to refer three women for mammograms and they all are later diagnosed\nwith breast cancer.\nNBLIC- Instituted a formal outreach initiative to establish a national system that will increase\ncancer prevention and control activities to reduce mortality in the black population.\nCancer Prevention Awareness Program-An intervention designed to increase awareness of\npreventable cancer risk factors among African-American Atlantans. The program targets lung,\nbreast, prostate and colon cancer.\nBEST Project-This project was developed to determine the efficiency of breast self examination\nby using a modified version of the palmar surface and the ACS standard technique using finger\ntips.\nProject Awareness- The primary objective is to increase the number of African American and\nother under served minority women to comply with the ACS breast screening guidelines. It has a\nthree tiered approach: (1) Education, (2) Easy Access to Affordable Screening, (3) Referral for\nFollow up Care\nWomen's Health Enterprise- A non profit family nurse practitioner managed holistic health\nprogram. They are committed to developing health care programs in response to the expressed\nconcerns of an under served community and offering these services to the citizens in the\ncommunity in which they reside. They accept Medicare and Medicaid reimbursements and offer a\nsliding fee schedule. They do referrals to Breast Test and More as well as working with the ACS\nTell-A-Friend Program.\nROSA- Reaching Out for Senior Awareness is a coalition of black churches that has a large\noutreach day every year. This year they presented an original play about mammography.\nThe 1995 mammography utilization rates for African American Medicare beneficiaries living in\nFulton and DeKalb Counties are 18.4 percent and 17.2 percent respectively. Of the 122 zip codes\nin these 2 counties, 11 represent 72 percent of the total number of African American Medicare\nbeneficiaries for these 2 counties. These 11 zip codes had mammography utilization rates in\n1995-96 ranging from 25 to 32 percent. These rates are still significantly lower than the Healthy\nPeople 2000 goal of 60 percent as well as overall Medicare utilization rates.\nThe conference attendees felt that there needed to be more education about Medicare benefits\nand educational programs concerning mammography procedures and early detection. Educational\nmaterial should be developed that is culturally, age and educational specific. They felt probably\nthe greatest impact is to have survivors deliver the education. They felt that the Witness program,\nprompt to physicians, church sponsored programs and the use of university/high school students\nto provide tr: resportation for community service ~redit Providers discussed the need to increase\nreferrals. All conference attendees expressed interest in participating at some level.\nSan Antonio, Texas\nThe planning conference for the Horizons Mammography Project in San Antonio was held on\nSeptember 11, 1997 to discuss locally based interventions for Hispanic American Medicare\nbeneficiaries. Particpants included 54 representatives from a variety of organizations involved in\nbreast health, the Hispanic community, and the 65 and older population, including:\nAmerican Cancer Society\nTexas Department of Health Breast & Cervical Cancer Control Program\nand other state agencies\nYWCA Encore Plus\nSusan G. Komen Breast Cancer Foundation\nimaging centers\nhospital systems\ncommunity health clinics\nsenior citizens groups\nThe conference presenters included Sylvia Fernandez, PhD, member and former chairperson of the\nGovernor's Commission for Women. A breast cancer survivor herself, Dr. Fernandez delivered a\npositive, motivating presentation titled \"An Invitation to Help Save Lives.\" The keynote address\ntitled \"Organization: The Need for Community Partners\" was given by Diana Rowden, Chairman of\nthe Susan G. Komen Breast Cancer Foundation, who is also a breast cancer survivor. She spoke very\neloquently about partnerships and how organizations can benefit from forming partnerships.\nParticipants were divided into two groups for concurrent breakout sessions. One group discussed\nthe barriers to mammography for Hispanic women 65 and older, while the other discussed barriers\nto health care providers. Later, the groups switched topics in order to give attendees the opportunity\nto participate in discussions on both beneficiary and provider issues. According to conference\nevaluations, participants felt that these discussions were productive.\nThe events surrounding the San Antonio conference were unique in that only two weeks prior to this\ndate, many of the conference participants had attended the Breast Cancer Round Table sponsored by\nAmerican Cancer Society and other organizations. Round Table organizers allowed HCFA 15\nminutes on their agenda to describe the Horizons Mammography project and invite participants to\nattend the September 11 conference. Discussions at the Round Table event yielded valuable\ninformation which provided a starting point for discussions at the Horizons Mammography\nConference. As a result, participants were not \"starting from scratch\" in identifying barriers to\nmammography and possible solutions/interventions to overcome them.\nDuring the discussions, participants confirmed the results of the marketing research conducted by\nHCFA prior to the conference, particularly on issues such as the tendency of elderly Hispanic women\nto rely on their church and the fact that both beneficiaries and providers need to be educated about\nthe Medicare mammography benefit. The latter issue, in fact, was one of the highlights of the\ndiscussions, as providers and beneficiaries alike were pleased to be informed of the upcoming\nchanges in Medicare's coverage of screening mammography.\nHowever, both provider- and beneficiary-oriented discussions had an overarching theme: The many\nsteps which take place from the time a Hispanic woman 65 or older hears a message about\nmammograms or breast cancer to the time she receives her results must be carefully examined and\nimproved upon in order for more women to obtain mammograms on a regular basis. For example,\na woman who hears a public service announcement in English about mammograms may not\nunderstand their life-saving potential if her first language is Spanish. If she does understand the\nimportance and actually calls to make an appointment for her first mammogram at a large health-care\nfacility, she may find it difficult to locate the mammography center, simply give up and never again\nattempt to get a mammogram. If she finds the mammography center, but encounters a clinician who\nis not able to explain the procedure in a language she can understand, she may get the mammogram\nbut never return for subsequent mammograms. Further, she may convey the negative experience to\nher friends, who may as a result never make an appointment for a first mammogram.\nThese examples represent only a few of the issues participants discussed with regal 1 to improving\ncommunication between health care providers and Medicare beneficiaries, specifically, Hispanic\nwomen 65 and older. But many are already implementing strategies to overcome these types of\ncommunication barriers. With the Horizons Mammography Project, local stakeholders will have a\nforum to share their strategies, organize a work plan which incorporates those strategies, implement\nthem, and increase the overall mammography rate by the year 2000.\nParticipants were given forms which allowed them to choose their level of involvement (as\nstakeholders, collaborators, or partners) and whether or not they wished to participate in a work plan\ndevelopment meeting which will be held by TMF in San Antonio at the end of September. As of\nOct. 1, 1997, 18 organizations have responded that they wish to be involved in the project, including:\nAlamo Breast Cancer Foundation\nAmerican Association of Retired Persons (AARP)\nBarrio Comprehensive Family Health Care Center, Inc. (community health clinic)\nBlue Cross and Blue Shield of Texas, Inc. (Medicare Part A)\nBlue Cross and Blue Shield of Texas, Inc. (Medicare Part B)\nCancer Therapy & Research Center\nHealthLink (Baptist Health System outreach program)\nMethodist Healthcare Ministries (Methodist health system outreach program)\nThe Mujeres Project (health outreach program for Hispanic women)\nNix Health Care System\nRadiology Associates of San Antonio\nSan Antonio Chapter of the Susan G. Komen Foundation\nSan Antonio Metropolitan Health District\nSanta Rosa Health Outreach\nSouth Texas Radiology Group, PA\nUniversity of Texas Health Science Center at San Antonio\nVisiting Nurses Association and Hospice of South Texas\nYWCA Encore Plus\nAlthough the first few months of this project will be spent organizing the three year plan, this core\ngroup of partners is planning a kickoff event in October, such as a press conference Early indications\nare that the San Antonio media will respond favorably to our efforts. Two articles in support of the\nproject and the conference were published in the San Antonio Express-News on September 12 and\n15, and on September 14, a 10:00 am news segment (on the local NBC television affiliate) titled \"En\nMi Barrio\" included footage from the conference and portions of interviews with conference\nparticipants about the importance of mammograms among Hispanic women. Additionally, a reporter\nfrom the local Univision (Spanish television) affiliate plans to profile the project in October.\nChicago, Illinois\nThe Chicago conference is scheduled for October 8 & 9 in Chicago. Over 100 key community and\nacademic leaders interested in breast cancer awareness and increasing mammography rates in the\nChicago African- and Hispanic-American populations have accepted an invitation to the conference.\nThe mammography conference agenda includes both national and local presenters who will inform\nthe conference attendees about the overall objectives and need for the Horizons Mammography\nproject, outcomes-based mammography project work previously performed in Chicago, and\nmammography outreach programs and efforts currently underway in Chicago. The speakers and\ninvitees lists both include diverse representation of providers, physicians, academicians, breast cancer\nsurvivors, advocates, coalitions, media, consumers, and government agencies. Stakeholder\nintroductions will be made, and networking will be promoted during lunch and breakout sessions.\nThe conference format will include presentations in the morning and minority-specific breakout\nsessions during both afternoons. Minority-specific expert panels will be available during the breakout\nsessions on day one, and discussions will be aimed at identifying barriers specific to minorities in\nChicago. Discussions during the break out sessions on day two will focus on partnership efforts to\novercome barriers and increase mammography rates.\nIn addition, the City of Chicago Public Health Department will hold their annual mammography \"kick\noff\" at the Horizons Mammography conference. Information about free mammography programs\noffered by the City will be given by the Commissioners of the Chicago Department of Public Health\nand the Chicago Department on Aging. The Mayor Dailey's wife will also address the audience.\nOf the 165,481 Chicago women enrolled in Medicare Part B during 1995, 52,285 were African-\nAmerican and 3,256 were self-identified as Hispanic-American. According to Part B claims data,\nonly 7,880 (15.1 percent) of the African-American women and 448 (13.8 percent) of the Hispanic-\nAmerican women received a mammogram during 1995. This data excludes women who do not have\nPart B coverage, were enrolled in a Health Maintenance Organization, or received free services.\nAccording to the Chicago area market analysis, barriers preventing older women from obtaining a\nmammogram include lack of physician referral, la * of perceived risk of getting breast cancer, lack\nof knowledge about the screening test or the guidelines for screening, and\nmisunderstandings about the Medicare mammography benefit.\nSeveral organizations are involved in outreach activities aimed at Hispanic- and African-American\nwomen. Several teaching facilities have conducted studies providing them insight into behaviors and\nbeliefs about breast cancer and the need for mammography. Some facilities and agencies have\nongoing programs in place geared toward access and cost issues with under-served populations.\nMany agencies offer literature promoting breast health The Illinois Foundation for Quality Health\nCare educates consumers through its speakers bureau, health fairs, and conferences.\nThe extent and limitations of existing programs and literature will be explored at the October\nconference.\nMammography final rule - Revised Questions and Answers (10/23/97)\n1.\nHow many women get mammograms, and when should they get them?\nThe National Cancer Institute (NCI) has estimated that during 1992, approximately 25 million\nmammograms were conducted. Based on a recent survey of facilities, mammograms are currently\nbeing performed today at the rate of about 41 million a year. Women should consult their\nphysicians to assess their personal risk for breast cancer and to develop an early detection plan.\nNCI recommends that women over 40 with no increased risk (i.e., based on family history) for\nbreast cancer get mammograms every 1-2 years.\n2.\nWhy is mammography important?\nBreast cancer is the second leading cause of cancer deaths among women, after lung cancer. It is\nestimated that by the end of this year, 180,000 - 181,000 new cases of breast cancer will be\ndiagnosed and that between 43,500 and 45,000 women will die from the disease. Early detection\nof breast cancer will be diagnosed, typically involving breast physical examination, breast self\nexamination, and mammography, is the best means of preventing deaths that can result if the\ndiagnosis is delayed until the onset of more advanced symptoms. Mammograms can reveal breast\ncancer up to two years before a woman or her doctor can feel a lump. More than 90 percent of\nthese early stage cancers can be cured.\n3.\nHow effective are mammograms in detecting breast cancer?\nWhile the quality of mammography has greatly improved and, under the final regulations, will\ncontinue to get better, the technology is not perfect. Up to 20 percent of cancers may not show\nup in a mammography examination. That's why women are encouraged to use the three tools that\nare complementary and provide the best chance of early detection of breast cancer:\nmammography, breast clinical examination by a health care provider, and monthly breast self-\nexamination.\n4.\nWhat is the potential effect of a poor quality or poorly read mammogram?\nIf the image quality is poor, the interpreter may miss a cancerous lesion at its initial stages. Such\nfalse negative diagnoses can delay treatment and result in avoidable deaths. Poor quality\nmammography can also lead to a false positive diagnosis, resulting in needless anxiety for the\npatient, costly additional testing, and unnecessary biopsies.\n5.\nWhat significant problems existed prior to the enactment of the Mammography Quality\nStandards Act?\nProblems with the provision of quality mammography services was documented by a number of\nstudies prior to the enactment of the new law. These studies showed that the image quality\nproduced by some mammography facilities was less than desirable and mammography service\nproviders lacked adequate quality assurance programs. It was reported that historically,\napproximately 30 percent of the facilities applying for accreditation failed on their first attempt to\nmeet the voluntary accreditation standards that were in place at that time. In addition, on a\nnationwide level, there were no universal standards for providing safe, reliable, and accurate\nmammography services. The Senate Committee on Labor and Human Resources held hearings on\nbreast cancer in 1992 and also found a wide range of problems with mammography practice,\nincluding poor equipment, lack of quality assurance procedures, poorly trained radiologic\ntechnologists and interpreting physicians, and lack of facility inspections or consistent\ngovernmental oversight. This raised concerns about missed detections of breast cancer.\n6.\nWhat does MQSA provide for?\nMQSA was passed on October 27, 1992, to establish national standards for mammography. The\nlaw requires that after October 1, 1994, all mammography facilities, except facilities of the\nDepartment of Veterans Affairs, shall be accredited by an approved accreditation body, and\ncertified by the Secretary of Health and Human Services. This authority to approve accreditation\nbodies and to certify facilities was delegated by the Secretary to FDA, which has been\nimplementing the law under an interim rule authority provided by Congress.\n7.\nWhat are the requirements of the MQSA final regulations?\nThe final regulations substantially raise the standards for mammography personnel, equipment,\nquality assurance and control, patient notification of results, the mammography medical report\nand performance of the accreditation body. These standards are similar to the \"temporary\"\nregulations that were in effect. However, some improvements have been made, for example,\nthe amount of training that physicians who interpret the x-rays must have has been increased. In\norder to continue to operate lawfully, all facilities must be accredited, meet these higher quality\nstandards, and be inspected every year.\n8.\nWhen will the final regulations go into effect?\nMost of the regulations will go into effect in 18 months, while some (equipment, quality control\ntests) will be phased in from a period of 18 months to five years. This will allow personnel to\nobtain training, purchase new equipment, and establish new procedures to comply with the rule.\n2\n9.\nHow did FDA develop the final regulations?\nDuring the 90-day comment period for the proposed final regulations--which were published on\nApril 3, 1996--approximately 17,000 copies of the proposals were mailed to all concerned\norganizations and individuals on FDA's mailing list, including every certified mammography\nfacility. Copies were also distributed by FDA personnel at professional meetings, and the\navailability of the proposal was announced in Mammography Matters, an FDA newsletter. More\nthan 1,800 members of the public provided comments on the proposals, and additional input\nresulted from eight meetings with experts from the National Mammography Quality Assurance\nAdvisory Committee.\n10.\nWhat has been the impact of the MQSA so far?\nAll fully-certified facilities have been inspected, and annual inspections have shown that overall,\nmammography facilities are complying with the interim standards. The first year's inspections\nfrom 1995-1996 showed that only 20 percent had serious or moderate findings, with only two\npercent being serious. The second year's inspections have shown further improvement. So far,\nfewer than one percent of facilities have been found to have serious problems. A recent GAO\nreport (still in draft) concludes that, overall, MQSA has had a positive impact on the quality of\nmammography services.\n11.\nWhat are the estimated costs and benefits of the new regulations?\nOn the basis of information available so far, FDA estimates the annual cost of compliance with the\nnew rule at about $40 million. The higher standards are likely to help save 75 additional lives and\nprevent tens of thousands of false positive examinations, a benefit whose estimated dollar value is\nwell over $200 million a year. The rule will also result in a small Medicare cost increase (less than\n$10 million annually).\n12.\nHow much do inspections cost per mammogram?\nFDA estimates that inspections cost 35 cents per mammogram.\n13.\nWhat will be the effect of the new rules on the cost of mammography?\nFDA had initially estimated that the cost of mammography could increase about $1.70 per\nscreening mammogram. Recent estimates have indicated an increase in usage of mammography,\nfrom about 25 million in 1992 to about 41 million in 1997. This would result in an average cost\nincrease of less than $1.00 per screening mammogram. The average price of a screening\nmammogram is about $90-100.\n3\n14.\nHow can I find out whether a facility is certified?\nThe names and locations of certified facilities can be obtained by calling the Cancer Information\nService at 1-800-4-CANCER (1-800-422-6237). The information is also available on the Internet\non FDA's home page at www.fda.gov/cdrh/dmqrp.html. All certified facilities must prominently\ndisplay a FDA certificate of their status\n15.\nWhere can I find out more about MQSA?\nYou can call 800-838-7715, the \"Mammography Quality Standard Act\" hotline of FDA's\nDivision of Mammography Quality Standards and Radiation Programs, or check FDA's home\npage at www.fda.gov/(drh/dmqrp.html on the Internet.\n4\nFROM:WUMENS\nOFFICE\n202-456-7311\nPRGET05\nRADIO ADDRESS\nFriday, October 24, 1997\nThe following guests will be in the Oval office during the Radio Address:\nStephen Baldwin\nKennya Baldwin\nWarren Batts Former Chairman & CEO, Tupperware Corporation\nCarmella Bocchino - Vice President, Medical Affairs. American Association of Health Plans\nNancy Brinker - Founding Chair, Susan G. Komen Foundantion\nChristine Brunswick- President, Greater Washington Baltimore Advocacy Group and Vice\nPresident, NBCC\nBecky Cain - President, League of Women Voters\nMyrna Candreia - Director, Encore Plus, YWCA\nKay Childs - Vice President of Human Resources, Shaklee Corporation\nBrian Connolly - Group Vice President, US Sales, Avon Products, Inc.\nNancy-Ann Min DeParle Deputy Administrator, Health Care Financing Administration\nMargaret Dixon - President, AARP\nRichard Dorff - President. Florida Association of Health Maintenance Organizations\nAnnette Drummond- - retired\nRonald G. Evens, MD - Chairman of the Board of Chancellors, American College of\nRadiology\nDebbie Feger-Papenfuss Creative Director, Provalent Communications\nKennetb Francese - Executive Director - - Compensation and Benefits, Chrysler Corporation\nMichael Friedman - Lead Deputy Commissioner, Food and Drug Administration\nBettye Green - St. Joseph's Medical Center\nTim Hammonds - President and CEO Food Marketing Institute\nVVJ\nFROM:WOMENS\nOFFICE\nd02-456-7311\nPHGE:07\nDiana Parsell Rowden - Chairman of the Board, Susan G. Komen Foundations\nDonna Sanborn - President. BE&K\nGino Santini - President, Women's Health Global Business Unit, Eli Lilly and Company\nManette Scheininger - Maidenform. Inc.\nPhillip Schneider - Managing Director, Public Affairs, National Association of Chain Drug\nStores\nJames Schwaninger Vice President. Government Relations. JC Penney\nElizabeth Shannahan - Special Assistant to the HCFA Administrator\nTamar Small - President, Provalent Communication\nMaureen Stratton - American Greeting, Director, Trade and Marketing Communication\nKathleen Swiger - Oncology Communications Manager, Zenecce Pharmaceuticals\nJohnna Torsone . Chief Personnel Officer. Piuicy Bowes, Inc.\nPatricia Underwood - National Secretary and Board of Directors, American Nurses\nAssociation\nHarold Varmus - Director, National Institues of Health\nFrances Visco - National Breast Cancer Coalition\nI'v' 00:07 OHT 18/07/01\nJane Hasselkus . Marketing Manager, Mammography, Easuman Kodak Company\nMaria Hinestrosa - Nueva Vida\nCarol Hochberg - SHARE Board Member\nFlorence Houn - Director, Division of Mammography Quality and Radiation Programs, Food\nand Drug Administration\nJoanne Howes - . Principal, Bass & Howes\nCarolyn Jennings - Direct Selling Association\nDebra Judelson, MD . President, American Medical Women's Association\nRichard Klausner - - Director, NationalCancer Institute\nMarie Langer. - NABCO member\nAmy Langer - - Executive Director, NABCO\nFreda Lewis-Hall, MD - Director, Lilly Center for Women's Health. Lilly Corporate Center\nJuanita Lyle - Breast Cancer Survivor, American Cancer Society. Inc\nJoanne Mazurki - Program Director. Avon's Breast Cancer Awareness Crusade, Avon\nProducts, Inc.\nEileen McGrath - Executive Director, American Medical Women's Association\nSteven McMillan - Manager, Federal Government Affairs, Zenecca Pharmaceuticals\nMichael Mennuti - Assistant Secretary, The American College of Obstetricians and\nGynecologists\nMichele Mullaney - - Project Director. Provalem Communication\nJulie Mulligan - Creative Director, 1 800-Flowers\nSue Muse President, Greater DC Chapter, Church Women United\nWilliam K. Ris, Jr. - Vice President, Government Affairs. American Airlines\nBruce Roberts - National Community Pharmacists Association\nYES 89:85 THE\nThe following eyests will listen 10 the Radio Address in the Receivels Room and come into\nthe Oval Office following the Radio Address for the receiving line:\nHelen Robinson\nRuby Jean Smith - aunt\nGlenna Dougan - Bill Clark's office manager\nDon Moak\nAzile Moak\nJudy Bacher\nAlex Bacher\nAndres Felipe Gomez\nEllen McCauley Gross . Georgetown classmate\nClare O'Callaghan\nJoan O'Callaghan - sister\nLaVerne Feaster (T)\nDan Pierce\nDonna Pierce\nChase Owens\nBill Hurt\nSue Hurt\nMichelle Savage\nCathy Slater (T)\nEdwene Stevens McCollum - Steve Stevens' sister\nMary Waites Lewey - Edwene's mother-in-law\nWeston McCollum Lewey . Edwene's niece\nSara Catherine Lewey - - Edwene's great-niece\nStephanie Streett\nAdrienne Erbach - OMB\nDun Erbach - Jad\nSharon Erbach - mother\nLois Fotinakes grandmother\nDave Leavy - NSC\nDaniel Leavy\nLouise Leavy\nDonald Leavy\nPatty McGuire Leavy\n178 RO:RT OHI 28/02/01\n051-23 97 20:24 FROM:WOMENS OFFICE\nd0c-456-7311\n(U:65557\nPHGE 109\nJim Leavy\nChristopher Leavy\nEdward Leavy\nKaitlin Leavy\nMegan Leavy\nBA Rudolph\nEarle Leighton Rudolpb\nMarjorie Holt Rudolph\nTerry W. Shoffner\nKaren Rudolph Shofner\nSamuel H. Holt Shoffner\nEarle Leighton Rudolph, Jr.\nEarle Leighton Rudolph III\nPeter Rudolph\nSue Rudolph\nAnil Kakani . OMB\nHemlata Kakani - mother\nJoslyn Mack - OMB\nBernice Mack - grandmother\nJulia Mack - mother\nSteve Mack - dad\nNational Mammography Campaign\nNational and Corporate Commitments\nUpdate 10/23/97\nNational Commitments\nAvon\nInvolvement of 425,000 sales representatives in woman-to-woman reinforcement\nof mammography importance: distribution of 15 million consumer flyers.\nSales brochure message about mammography importance: 60 million print\nimpressions.\nContinuation of funding for 250 community organizations that, through outreach\nto medically underserved women, link them to Medicare and other mammography\nservices.\nEli Lilly\nThe Breast Education and Mammography Screening Center at its Indianapolis-\nbased corporate center is Indiana's only on-site mammography center dedicated to\nemployees, retirees, and spouses over the age of 40 and offers its services and\neducational material free of charge.\nThe Lilly subsidiary PCS Health Systems, Inc. Is using its on-line information\nsystem to communicate with nearly every U.S. pharmacy to encourage women age\n65 and over to get their Medicare-covered mammograms every two years.\nZenecca, Inc.\nSupports Initiative through the National Breast Cancer Awareness Month\ncampaign of which National Mammography Day, October 17, is a key component.\nOne of the first companies to provide on-site screening to its employees and has\ndeveloped a comprehensive guide to help any employer institute mammography\nprograms for their employees.\nCorporate Commitments\nAmerican Airlines\nProvide mobile mammography units for 100,000 employees during October.\nDevelop promotional materials for in-flight videos that educate passengers on the\nvalue of early detection, including the MMI message.\nDistributed information in honor of Breast Health Awareness Month through 3\nmailings sent to 75,000 employees.\nAmerican Association of Health Plans\nEncouraged and facilitated the distribution of MMI materials to consumers and\nproviders at state health fairs and clinics coordinated by member health plans\nacross the country.\nDistributed information about the MMI to nearly 500 Directors of Communication\nat member health plans and affiliate state HMO associations.\nPublished a public service announcement in the Novertber/December 1997 issue of\nHealthPlan, a bi-monthly magazine with nearly 8,000 subscribers.\nShowcased the MMI in the May/June 1997 edition of the Medical Affairs Issues\nReport which reaches nearly 1,000 health plan chief executive officers and medical\ndirectors.\nShared information about the MMI with AAHP's Women's Health Task Force, a\ndiverse group of health plans that oversee the development of the Women's Health\nInitiative--which is identifying best practices/model programs in four critical areas\nof women's health: breast cancer decision making/treatment, menopause/hormone\nreplacement therapy, domestic violence, and obstetrics/pregnancy care.\nAmerican Greeting\nPresent Point-of-Purchase display for use in Mother's Day cards that includes a\nspecial \"reminder\"card in greetings that reaches 30,000 stores.\nBE & K Engineering\nProvided on-site mammograms for a nominal amount to employees, retirees and\ntheir spouses along with other preventive tests during a annual wellness fair.\nChrysler Corporation\nConduct special corporation-wide education programs on breast cancer awareness.\nThis program is available at 32 Wellness Offices and 72 other corporate locations.\nDistribute 7,000 Shower cards for breast self-examination.\nChrysler Times awareness feature on Initiative to reach over 200,000 employees\nand retirees\n\"Tel-A Friend' notice posted in Chrysler locations encouraging employees to\ntelephone their mothers, sisters, friends, and co-workers to remind them of the\nimportance of mammography. For every person an employee calls, Chrysler will\naward them one \"Wellbuck (an incentive to Chrysler makes available to employees\nto encourage a healthy lifestyle.).\nDirect Selling Association\nCoordinate efforts among over 2600 executives of direct sales companies to\nproduce materials regarding mammograms for circulation. This effort has the\npotential to reach 6 million direct selling women through monthly magazines,\nvideotapes, audiotapes and payroll and bonus check mailings.\nEastman Kodak Company\nDistribute information with Supplement piece in September/October Employee\nNewsletter that reaches 50,000 retirees.\nDistribute 2,000 posters to communities with Eastman Kodak plants as well as\nmaking mammograms available at the worksite for Kodak employees.\nThousands of female employees at Colorado Plant given awareness pins and asked\n10 distribute one to an older women,\n001-23\nWOMENS\nOFFICE\n11S)-9CH-2028\nFlorida Association of Health Maintenance Organizations\nConducted free mammograms at the state capitol in March and at Florida area\nmalls the first weekend of each month\nProvides a toll free telephone number for breast screening information and to\nrequest educational materials. Encouraged worksite programs to their employer\ncustomers.\nFood Marketing Institute\nDevelop brochure with National Cancer Institute, National Urban League and the\nU.S. Department of Health and Human Services. The National Urban League will\ndistribute to 114 National Urban League affiliates. The Food Marketing Institute\nwill distribute to 1500 members including their subsidiaries--food retailers and\nwholesaler and their customers in communities across the country.\nJ.C. Penney\nDistribute information through insurance policy holder newsletter that reaches 1\nmillion people.\nDistribute message in October credit mailing that reaches 15-20 million.\nDistribute material through Eckerd Drug Stores that reaches 2800 stores.\nMaidenform, Inc.\nPlace 11/14 posters/signs with MMI message in dressing rooms in 100 outlet\nstores for Mother's Day.\nNational Association of Chain Drug Stores\nNACDS member pharmacies will participate with American Greetings in a special\nMother's Day outreach program, as well as provide information to 88,000 chain\npharmacists in over 30,000 chain operated community pharmacies about the\nMedicare benefit and referral sources.\nNational Community Pharmacists Association\nPublish article. including availability of materials, in October 1997 NCPA Annual\nConvention issue of America's Pharmacist. Will reach nearly 40,000 independent\ncommunity pharmacies via mail. An additional 5,000 issues are distributed on-site\nat the October '97 annual convention.\nPublish article on the Initiative in October '97 issue of the NCPA Newsletter.\nAnnounce the White House Medicare Mammography Initiative during the General\nSession of the NCPA Annual Convention in Denver,, October 25-29, 1997. More\nthan 5,000 attendees Distribute material in Convention Press Room and in the\nConvention Exhibit Hail\nPost information on the Initiative on the NCPA web site [www.mepanet.org]\nBroadcast programming, ads, or general announcement on our soon to be\nlaunched in-store relevision network NPTV. which will reach hundreds of\npharmacies and hundreds of thousands of consumers.\nWOMENS\nPitney Bowes\nProvide on-site mammograms for female employees over 35.\nWork with area hospitals on providing mammograms for uninsured and indigent\nwomen'\nShaklee Corporation\nMailed notices to its 14,000 independent distributors and to all its employees\nalerting them to Breast Cancer Awareness Month.\nThe Longaberger Company\nFor every Horizon of Hope Basket purchased, the company donates $2.00 to\nbreast cancer research and education awareness project. Each basket contains a\nreminder sticker for an annual mammogram that reaches over 2.5 million women\nPublish article on the Initiative in Company newsletter that reaches 40,000 sales\nrepresentatives.\nTupperware Corporation\nSent memorandum 10 approximately 1,000 U.S.-based Associates on the\nimportance of regular mammograms and highlighting women 65 and older and the\nInitiative\nDevelop poster with Initiative message to be highlighted at the Tupperware's U.S\nDistributor Conference which reaches 350 franchised distributorships supporting\nthe sales force in the U.S.\nPublish article on Initiative in Distributor Bulletin insert that is distributed to the\nentire U.S. sales force, of approximately 100,000 women.\n1-800-Flowers\nDevelop a mailer insert with the Initiative message that will be included in a\nreminder package to be sent to approximately 18,000-20,000 consumers.\nOFFICE\nMedicare Mammography Initiative\nEditors' Commitments\n10/24/97\nWOMEN'S MAGAZINES\nChild\nPamela Abrams\nPlans to include article in November\nissue.\nCirculation: 740 thousand.\nCosmopolitan\nBonnie Fuller\nPlans to include a large feature in\nOctober issue (\"A to Z\" of\nBreast Cancer).\nCirculation: 2 million.\nElle\nElaina Richardson\nPlans to include MMI article in\nOctober issue.\nCirculation: 900 thousand.\nFamily Circle\nSusan Ungaro\nPlans to include a report on\nbreast cancer in October\nissue.\nCirculation: 5 million.\nFitness\nSally Lee\nPlans to address MMI in October\nissue.\nCirculation: 750 thousand.\nGood Housekeeping\nDiane Salvatore\nPlans to address breast cancer and\nMMI in October. November\neditor's article will address\nMMI.\nCirculation: 5 million.\nHealthy Living\nRachel Newman\nPlans to print an article on MMI in\nCountry Living\nthe November issue.\nProvides free mammograms to\nemployees.\nCirculation: 1.6 million\nLadies' Home Journal\nSusan Crandell\nPlans to cover MMI in October issue\nCirculation: 17 million.\nLatina\nPatricia Duarte\nPlans to run feature article in either\nNovember or December\nissue.\nCirculation: 300 thousand.\nMademoiselle\nElizabeth Crow\nPlans to cover MMI in October issue\nCirculation: 13 million.\nMcCall's\nSally Koslow\nPlans to include major medical piece\non breast cancer in October\nissue.\nCirculation: 4.3 million.\nParenting\nJanet Chan\nPlans to discuss breast self-\nexams in October issue.\nCirculation: 1.1 million.\nParents\nSarah Mahoney\nPrinted article on Breast\nCancer and MMI.\nCirculation: 12 million.\nRedbook\nKate White\nPlans to include 3 feature article in\nSeptember and an OB/GYN\ncolumn in October on breast\ncancer.\nCirculation: 13 million.\nself\nRochelle Udell\nPlans to include 16 pages on MMI.\nVice-President involved.\nCirculation: 1.16 million.\nSeventeen\nMeredith Berlin\nPlans to print MMI article in October\nissue.\nCirculation: 2.4 million.\nVogue\nAnna Wintour\nPlans to run an article on MMI in\nMary Murray\nSeptember issue.\nCirculation: 1.19 million\nOFFICE\n10/03/97 WED 17:35 FAY\nPROVIDENT\nCandice Bergen:\nFOR HUNDREDS OF THOUSANDS OF AMERICAN WOMEN, COPING WITH\nBREAST CANCER IS A FACT OF DAILY LIFE ONE THAT THEY DEAL WITH\nWITH COURAGE, DIGNITY. AND AT TIMES EVEN HUMOR.\nFOR MOST WOMEN, A REGULAR MAMMOGRAM IS A CLEAN BILL OF\nHEALTH. FOR OTHERS IT CAN BE THE BEST AVAILABLE TOOL FOR\nDISCOVERING THE DISEASE EARLY, WHEN IT IS EASIEST TO TREAT.\nI OUT OF 8 AMERICAN WOMEN WILL BE DIAGNOSED WITH BREAST\nCANCER IN HER LIFETIME-WITH AGE THE LEADING RISK FACTOR.\nSO USE YOUR HEAD AND YOUR HEART AND GET A MAMMOGRAM.\nMrs. Clinton:\n(video taped wrap-up)\nFROM:WORKS\nVALENT\n001 Oxford Vailey Road\nEldg 1503\nommunication\nPA 10007\nTol (215)\nFox (215) 321-8103\n(Stephen Baldwin reading the paper. Moners watering plants or other\nactivity.)\nMom, this article says that most women your age don't get regular mame\neven\nthough age is the leading risk factor for beast acer.\nMy Danny. He's so smart.\nNo mom, I'm not Danny It goes OD to say that 180,000 new cases of breast cancer\nwill be diagnosed this year, over half of them in women over 65.\nMy Billy, he's so good with numbers.\nMom, get it straight, I'm not Bill\nAnd starting January 1, Medican ys for\nmammograms for women 65 and over. Now there's no excuse!\nAlec. You'r SO compassionate\n(Stephen puts down the paper and addresses Ss moth STectionately)\nMom. there's one thing you always get right...\nencouraging women 10\nregular\nmammograms because early detection can save lives.\n(Mrs. Baldwin reaches over and hugs Stephen)\nI never confuse the import Stephen.\nA member of the OCC Group of companies\n700 5\nVALENT\n301 Oxford Volley Road\ntime 1503\ncommunicat\nPA 19067\ntol (215) 321-4000\nin (215) 321-4104\nNational Mammography PSA\nScript for Whitney and Bissy Houstoh\n(Open on Grandmother Playing with Grandchild)\nSissy Houston:\nHoney. how was the baby's check-un?\nWhitney:\nJust fine Mama More importantly how about your mammogram?\nSissy:\nEverything was just finemand my Medicoam benefit helped pay for it 100.\nWhitney:\nGreat mama. Just remember that Medicare now helps pay for mammograms ever year so\nmake an appointment now for your manumogram for next year.\nSissy:\nGirl...you can be such a nag. I guess it must be use. We all turn into out mothers\neventually.\nWhitney:\nThen it's a good thing that TY mame's so awarome.\nA member of the OCC Group of companies\nINTERNATED\nIT:ST CER\n000\nDelied doldi UFFILL\nROVAL\n301 Osford Valley Date\nfldg 1503\neommunica j\nTurdley. PA 19007\nit 1215) 321-411\nFor (215) 321-4103\nWhite House Mammography Campaign\nCelebrity TV PSA : 30\nFinal 10 second wrap\nMrs. Clinton:\nBE SURE THE FIRST LADY IN YOUR LIFE KNOWS ABOUT THE\nIMPORTANT NEW BENEFIT THAT PAYS FOR ANNUAL SCREENING\nMAMMOGRAMS FOR ALL MEDICARE ELIGIBLE WOMEN AND\nOLDER.\nENCOURAGE HER TO ORT A MAMMOGRAM IT'S A PICTURA AT CAN\nSAVE HER LIFE.\nA member of the OCC Group of completes\ntoo (7)\n31\n10/23/67 THU 17:36 FAX 202\nNational\nBreast Canchr Awareness Month 997\nfy\nStates of America\nsmalled\nEvery year we\nthe\nmonth\nof\nincome on breast cancer and\n10\nour national\ncommitment to exadicate\nit.\nBut\nfor\nmerican women and their 5am\n3 friends. breast\nCancer\nis\nover their lives\ndecade\nDearly\nof the\ndisease will\now stectost\ncancer Is knowledge:\n3 causes and\nknowledge about\nUnioistration has established\nAction Plan\non Breast Cancer\nthe country in 8 collaborative\nfind out more\nabout the disease\nThe Department\naking the lead la this nation\nuch education\nand\nand Rasearch:\nthrough nation\nat the Contors for Disease\ndi Prevention:\nthrough cartin\nFood and Drug Administra\nsh prevention\nservices and\nincreased\naccoss 10 clinics\nand beneficiaries\nof Defense\nand Dupartment\nof\nDeformed\nDated a brosst\ncencer research\n&\nbreast cancer. increase SUP.\nand improve\nthe quality of life\nWe CAR be\nof the most promising\nachievements\nis\nin\nthe\nlearned that\nbetween\nbreast CLAIM\nU.e\nwe must\noncure prog\nsoly to INVENCE\nhealth-\nnot as d Deals for\nyear 1 have used ii:- Consies:\npass a law that\nprevents bealth\nagainst individuals 00 the\ninformation.\nHigh-quality\na\npowerfully\nNort 10 detect\nbreas: cancer\nThe National Cancer\nerican Cancer\nSociety, and\nmammog\nrapsy scrushing\nsign legislation that\nbeneficiaries\nwith cost-staries\nThe First LADY has also\nnuel cempaign\nto encourage Dider\ncreenice beautits\nPHGD\n001-25\n91\ndold(\n10/23/97 THU\nWe have mal\nil Breast Concer Awareness Chis year: recent\ndate show that\nknowledge\n!ne reside:\nwomen\nknow\n40001\nstrly detection,\nreceive recom\nhearth can\nformation. Let\nDE continue\nworking\ntogether.\nfriends can\nlive long. bealthy\nNOW. THEREFO:\nFrident of the United States\nInverice. by virtue\nof the authority\nand 16-5 of the United Stat\nhereby proclaim\nOctober 11147 A:\nMores ! call upon\nusuals. businesses\ncommunities. :-\ncluntrons. and all the people\nUnited States\nin refiser CAMP\nour knowledge about breast\nand 10 publicly\nrealize our nation\nthis disorse.\n[N WITNESS WHEREOF\nhand this first day of Octol\n2.e year of 0.1\"\nLotd Director\n79\nAmeric:\nthe its hundred\nare\n09/21/1997\nPAGE 03\na\n[THEPRES\nout to all woment m\nord\nsave your life. They\nall women over 401\nprofessionals, was\nresearch and medical\n?us\nnewest\npublic\nHealth\nfor\nOur success :-\nRisce\nmammogram,\nvast majority of crear\nby as much as 76%\nfacilities, health provi\nWith these Ste\naffirm commission\nThanks for lie\n,"
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