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Withdrawal/Redaction Sheet
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. memo
Sandee Katz to Jennifer Klein re requested information [personally
04/04/1995
b(6)
identifiable information] [partial] (1 page)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Jennifer Klein
OA/Box Number: 13530
FOLDER TITLE:
Mammogram Event/WHCOA [White House Conference on Aging]
2014-0536-S
kc1560
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRAJ
b(1) National security classified information [(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRAJ
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy |(b)(6) of the FOIA]
personal privacy |(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes |(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions ((b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells [(b)(9) of the FOIA]
RR. Document will be reviewed upon request.
05/15/95
04:57
FIRST LADY HILLARY RODHAM CLINTON
WHITE HOUSE CONFERENCE ON AGING
MAMMOGRAPHY SESSION
MAY 4, 1995
[Acknowledgements: Senator David Pryor, Chair of WH Conference
on Aging; Donna Shalala, Secretary of HHS; Fernando Torres-Gil,
Assistant Secretary for Aging, HHS; Bob Blancato, Executive
Director, WH Conference on Aging; University of Maryland "Reach
Out for Health" Service; panel participants]
Thank you, Senator Pryor, for that kind introduction. We
are going to miss your generous spirit and wisdom in the
Senate when you retire.
I would like to thank everyone for coming here this week for
this conference. Your participation is critical if we are
to find answers to the wide range of issues confronting so
many older Americans today.
Medicare and Medicaid -- and the cuts to these programs
being considered in Congress -- are some of the most
important issues that you are addressing at this conference.
We're here today to talk about just one of the important
benefits provided by Medicare. But I want to take a minute
to put this issue in context. As the President said
yesterday when he spoke to you, Medicare and Medicaid are
examples of government that works. These programs have
lifted millions of older Americans out of poverty and have
helped !millions more manage to pay for needed health care
services, like long-term care.
As the President also said, we need to address the growth in
federal health care costs, but there is à right way and a
wrong way to do it. The wrong way is to cut these programs
to pay for tax cuts for only the most well-off Americans.
The right way is in the context of health care reform. And
as we have said all along, we must measure any health care
proposal, including any changes in Medicare and Medicaid, by
four principles -- coverage, choice, quality and
affordability. Does the proposal go backward and increase
the number of uninsured, or does it move us forward? Does
it force older Americans into managed care, or does it give
people options and incentives? Does it make these programs
more efficient without threatening quality of care? And
will the proposal increase costs for beneficiaries so much
as to make quality medical care unaffordable for older
Americans?
WALZAR GR-8 -G 0701 Xojax:10 IN7S
05/15/95
04:58
We need to think about changes that make sense. But we also
need to think about some of the things that government is
doing right -- and I think the Medicare mammography benefit
is a perfect example.
As many of you know, a serious threat to the health of
America's older women is breast cancer. One out of eight
women in America will contract breast cancer in her
lifetime. Eighty percent of new breast cancers occur in
women aged so and older, and half of all new cases occur in
women 65 and older. The threat of breast cancer touches
every American. We all know someone -- a grandmother, a
mother, a sister, an aunt, a daughter, a friend, or in my
case, a mother-in-law, who has suffered or is suffering from
this disease.
In 1991. thanks to the hard work and commitment of many of
you here today, mammography was added as a Medicare benefit.
That is why I was so concerned to learn that less than 40%
of women aged 65 and older on Medicare have used the
Medicare mammography benefit.
Over the past few months, I have had the opportunity. to meet
with older women, health care professionals, and breast
cancer survivors. Through these meetings -- which we called
"listening sessions" -- we were able to gain a better
understanding of how we could increase the use of
mammography among older women.
I learned a great deal from the doctors, nurses, and older
women who took part in the sessions, as did the experts from
the Health Care Financing Administration and the Public
Health Service's Office on Women's Health.
Earlier this week, I was delighted to kick-off the Clinton
Administration's campaign to increase awareness of the
importance of mammography among our nation's older women.
In honor of Mother's Day, we are calling the first phase the
"Mama-gram" campaign. The campaign will include public
service announcements and store displays, bill inserts and
grocery store bags carrying information about mammography
and Medicare. In addition, "mama-grams" -- pre-printed
mammography reminders -- will be available at greeting card
shops and FTD florists to be slipped into a Mother's Day
card or bouquet. The campaign will continue as a year-long
Medicare and mammography initiative.
In about ten days it will be Mother's Day, and I know I can
count on everyone in this room to use it as an opportunity
to show your love by encouraging your mother, sister, aunt,
daughter, or friend, to get a mammogram to help them live
longer, healthier lives.
05/15/95 04:59
'D'
Because those of you here for the White House Conference on
Aging are leaders and role models in your communities, you
have a unique opportunity to carry this message back to your
friends, colleagues, and neighbors and adapt it so that it
will get results in your community.
###
0 WAZZ:S 6 CR-F -C ' 0701 Jatdooalal 10 INSC
$ 8:60/98
EXECUTIVE OFFICE OF THE PRESIDE
02-May-1995 01:51pm
TO:
Jennifer L. Klein
TO:
Barbara D. Woolley
FROM:
Karen R. Guss
Office of the First Lady
SUBJECT:
Bulllet points re: WHCoA panel discussion
SUGGESTED ORDER OF DISCUSSION
AND ISSUES TO BE DISCUSSED WITH THE PANELISTS
[Opening remarks]
[Panel members introduce themselves - - they will know not to begin
their stories at this time.]
Dr. Smits
?
description of post-Mother's Day mammography awareness campaign
?
how the mammography benefit provided by Medicare works
Dr. Blumenthal
?
elaborate on risk of breast cancer among older women, including
why breast cancer risk increases with age
?
why mammography is such a good tool for early detection in
older women
?
what Federal government is doing
?
other steps older women should take to protect breast health
(e.g., clinical breast exam)
Dava
Gerard
Dr.
(breast surgeon)
?
description of mammography procedure
?
what are the next steps if the mammogram comes back positive
?
experiences demonstrating value of early detection
Dr. Gleeson
?
experiences with older women and mammography, including
barriers to mammography
?
ways to talk to older patients about mammography
?
reasons some doctors do not talk to older women about
mammography
?
level of awareness among physicians about the Medicare
mammography benefit
?
point out that older women are more likely to see specialists
than primary care physicians and that even doctors whose
specialties are not associated with breast health should talk
about mammograms
?
ways to convince health care professionals to talk to their
older women patients about mammography
five senior women
?
frequency of mammograms
?
reason for having mammograms, including whether doctor
recommends mammograms
?
awareness of Medicare benefit
?
concerns about mammography (embarrassment, fear, expense,
belief that not at risk, etc.) and how these concerns were
overcome
?
benefits of mammography (early detection, peace of mind)
?
experiences with friends who do not have mammograms
?
how to persuade older women to use the Medicare benefit
Dr. Blumenthal
?
summarize other barriers that have come up in the literature or
previous listening sessions
?
racial, cultural, and other disparities in mammography use rate
and possible explanations
senior expert
?
best ways to reach out to senior women and their families
?
how we can work with area agencies on aging and other local
resources to spread the word about the Medicare mammography
benefit and the importance of mammography for older women
Modern Maturity writer
?
how the media can help reach out to senior women
?
what the private sector is doing to encourage mammography in
older women and how the Administration can work most
effectively with the private sector on the mammography
awareness campaign
Delta Project rep
?
special barriers to mammography screening in the African
American rural community
?
how the Delta Project reaches out to older women
?
what the Delta Project shows us about adapting breast cancer
education to be most effective in a given community
?
how government can work with local initiatives like the Delta
Project
April 30, 1995
MAMMOGRAPHY AWARENESS CAMPAIGN KICK-OFF
DATE:
Monday, May 1
TIME:
11:45 a.m.
LOCATION:
East Room, White House
FROM:
Karen Guss, Liz Bowyer
I.
PURPOSE
To launch the Medicare mammography awareness campaign and highlight its first phase, the
"Mama-gram" campaign.
II.
BACKGROUND
This event will serve as the formal kick-off of the Administration's mammography awareness
campaign. At the event, the mammography awareness and "Mama-gram" initiatives will be
announced and the video news release and public service announcements that will be used
during the campaign will be unveiled. Program speakers will include you, Secretary Shalala,
and two senior women (profiles attached). During your remarks, you will unveil the video
news release and the PSAs. At the end of the program, you will give a Mother's Day bouquet
to Clara Morrell, a 78-year old breast cancer survivor who attended the listening session in
Des Moines (profile attached). She will not be expecting the bouquet or to play any part in
the program.
The audience of approximately 180 will be comprised of participants from the listening
sessions, corporate sponsors of the "Mama-gram" campaign, public relations professionals
involved in the campaign, officials from HHS and representatives of various seniors groups,
breast cancer advocacy groups, and health professional organizations (see attached list of
corporate sponsors, public relations firms and organizations sponsoring the mammography
awareness initiative and/or "Mama-gram" campaign).
Before the formal program begins, you will take official photos with the corporate sponsors of
the "Mama-gram" campaign and the public relations professionals who worked on the
campaign (see attached list). The sponsors who have contributed the most to the campaign
are the PSA sponsors (Zeneca Pharmaceuticals, Avon, Inc., Bristol-Myers, PCS (a subsidiary
of Eli Lilly)) and FTD, American Greetings, the Food Marketing Institute, and the National
Association of Chain Drug Stores (see attached list of each sponsor's and each public relations
firm's contribution). You will receive a copy of a brochure about breast cancer from Avon, a
plaque of the "Mama-gram" point-of-purchase display from American Greetings and the Food
Marketing Institute, and a bouquet of flowers from FTD.
After you meet with the sponsors, you will take official photos with the "Expedition
Inspiration" Climbing Team (see attached list). The Expedition Inspiration Climbing Team is
a group of breast cancer survivors who climbed Mount Aconcagua in the Andes, the highest
mountain outside the Himalayas. Three members of the team reached the 23,000 foot
summit, and the others attained their goals of from 15,500 to 21,500 feet. The team
members, ranging in age from 22 to 61 and including two grandmothers, carried 170 Tibetan
prayer flags inscribed with the names of over 400 women who have had breast cancer. The
Climbing Team is just one part of Expedition Inspiration, a two-year campaign launched in
early 1994 by the Breast Cancer Fund in San Francisco, California, to raise awareness about
breast cancer and money for breast cancer research, education, and support services. Andrea
Martin, the founder of the Breast Cancer Fund, and Laura Evans, the founder of Expedition
Inspiration, will present you with a certificate of the prayer flag tribute to the memory of
Virginia Kelley (the actual flag was carried to the mountain and will become part of the
Breast Cancer Fund's permanent prayer flag exhibit) and a framed prayer flag dedicated to
you.
Mama-gram Campaign
The "Mama-gram" campaign will feature a number of promotional efforts centering around
Mother's Day, including greeting and floral card inserts, store displays, department store and
drug store billing inserts, grocery store bags, and public service announcements. In addition,
the Health Care Financing Administration will distribute "mammography kits" with
information on Medicare and the mammography benefit to various advocacy and professional
organizations, Medicare carriers, and HMOs and other providers (see sample kit). These kits
will continue to be distributed throughout the year.
A series of PSAs have been developed, two of which will be unveiled at this event. One
spot, featuring your voice-over, highlights mammogram "success stories" -- including breast
cancer survivors who discovered their cancer through mammography and are leading active
lives today and a woman who talks about how her clean mammograms give her peace of
mind. In the second PSA, the President talks about his mother's struggle with breast cancer
and the importance of mammography in a voice-over, as still pictures of his mother appear on
the screen. Both PSAs include the slogan, "Get a mammogram. It's a picture that can save
your life." Although the PSAs are being unveiled during the "Mama-gram" campaign, they
will continue to be used after Mother's Day.
The video news release which will be shown at the "Mama-gram" kickoff is also suitable for
use after Mother's Day. It is drawn from the listening sessions in Hollywood, Florida and San
Diego.
Mammography Awareness Campaign
After the "Mama-gram" campaign in May, the awareness campaign will continue throughout
the year with additional PSAs and outreach efforts through Medicare carriers and
intermediaries, state health departments, local aging agencies, and advocacy and professional
groups. In addition to Mother's Day, the campaign may also be integrated into activities
surrounding Grandparents Day in September and Breast Cancer Awareness Month in October.
New England Journal of Medicine Article
In an article appearing in the New England Journal of Medicine on Thursday, April 27, 1995,
Dr. Jan Blustein of Columbia University describes a study he conducted of Medicare claims
data for 1991and 1992. The study found that only 14 percent of women without Medigap or
other supplemental insurance obtained a mammogram during those years. (Only about 11
percent of women on Medicare aged 65 and older have Medicare only.) The study also
looked at women with supplemental health insurance through their employers, women who
paid for their own supplemental insurance, and women covered by Medicaid. It found that
45% of the first group, 40% of the second group and 24% of the third group had had
mammograms.
The study's author noted that cost is not the only factor in women's decisions about
mammograms; he found that less than half of the women for whom expense was not a
factor obtained mammograms. He was quoted by Reuters as saying that his findings
"underscore the opportunity to encourage and educate older women about mammography" and
Medicare coverage for mammograms.
Attached are articles about the study as well as the New England Journal of Medicine article
itself.
III.
PARTICIPANTS
Program Participants
HRC
Secretary Shalala
Zennie Cummings
Lou Glasse
Clara Morrell (receives bouquet only)
IV.
SEQUENCE OF EVENTS
See scenario.
V.
PRESS
Open press.
VI.
REMARKS
Prepared by Karen Guss and Lissa Muscatine.
THE
COMMONWEALTH
FUND
HARKNESS HOUSE
ENHANCING
THE COMMON GOOD
ONE EAST 75TH STREET, NEW YORK, NY 10021-2692
SINCE 1918
(212) 535-0400 FAX (212) 249-1276
Release Embargoed until 6 P.M., April 26, 1995
For Further Information:
Mary Lou Russell (212) 606-3842
Peg Byron (212) 606-3841
NEWS RELEASE
MEDICARE COVERAGE FOR MAMMOGRAPHY INADEQUATE
New York, New York, Thursday, April 27, 1995--In the first two years of Medicare coverage for
screening mammograms, more than 60 percent of eligible women were not tested for early signs
of breast cancer, reports a new study sponsored by The Commonwealth Fund and published in
today's issue of the New England Journal of Medicine. This figure climbed to more than 85
percent for women who did not have supplemental coverage and faced additional costs in order
to use the Medicare benefit. The study is the first to demonstrate that inability to pay a share of
the costs for mammograms limited the extent to which women took advantage of Medicare's
coverage of the screening tests for breast cancer.
"The numbers are alarming, particularly for those older women who can't afford supplemental
coverage," said Karen Davis, Commonwealth Fund president. "The study finds that women with
private insurance are three times as likely, and those with Medicaid are twice as likely, to have a
mammogram than are those Medicare beneficiaries who must pay out-of-pocket a portion of the
mammogram cost. The end result is a system that forces women without full coverage who are
most at risk to choose between being screened for early breast cancer or buying prescription
drugs and other essential items."
The study conducted by Jan Blustein, M.D., Ph.D., of Columbia University's Department of
Medicine, College of Physicians & Surgeons, examined the outpatient hospital and physician
billing files of 4, 110 Medicare beneficiaries in 50 states, who were 65 or older, had no history of
breast cancer, and who were not hospitalized or living in a nursing home. Five hundred of these
women were covered only by Medicare, 476 had Medicare and Medicaid, and 3,134 had private
supplemental health insurance.
-more-
2
Commenting on the study, Dr. Harold Sox, chairman of the U.S. Preventive Services Task Force
and chairman of the Department of Medicine at Dartmouth-Hitchcock Medical Center, said,
"This study raises many questions. The low mammography rates could be due to poor access to
a primary care physician, physicians who do not recommend mammography for older women, or
inability to pay for a mammogram. The author's analysis shows that inability to pay is clearly a
factor."
"Requiring co-payments for preventive services is an obstacle to the effective mass screening of
older women for breast cancer," said Blustein. "Breast cancer is the most common cancer in
women, and the likelihood of the disease increases with age. Early detection can be life saving."
In the past two decades, key organizations, including the National Cancer Institute and the
American Cancer Society, have endorsed annual mammographic screening in women older than
50 years, while other experts recommend less frequent regular screenings. On January 1, 1991,
Medicare instituted reimbursement for screening mammography once every two years.
However, Blustein shows that women's use of Medicare's benefit fell substantially below
recommended levels during the period studied.
In order to take advantage of Medicare's screening benefit, the report said, a woman without
supplemental insurance must pay the annual Medicare deductible of $100, provide the 20 percent
co-payment for mammography ($11.96 in 1994), and possibly pay another 15 percent ($8.94 in
1994) if the provider does not accept the Medicare rate of $59.63. The study also noted that
some, but not all, supplemental policies cover preventive care services.
Blustein's study showed that a total of 36.9 percent of older U.S. women obtained mammograms
during the first two years of Medicare's coverage for the service, with use highly associated with
whether they had supplemental insurance. Women with private supplemental insurance were
three times as likely as women without that coverage to get mammograms (44.7% of women
with employer-sponsored supplemental insurance and 40.1% of women with self-purchased
supplemental insurance). Of women with supplemental coverage through Medicaid, 23.9
percent obtained mammograms, nearly twice as many as those with only Medicare coverage.
Only 14.4 percent of women without supplemental insurance received mammograms.
-more-
3
Her study also showed that minority women and women of low income and education levels
made up a disproportionate number of those who did not receive mammograms. These groups
also were less likely to have supplemental insurance. The median annual income in the overall
study group was $12,000, which, the study notes, can mean a woman is not poor enough to
qualify for Medicaid but cannot afford supplemental insurance which can cost about $850
annually.
Even among women with private supplemental insurance, fewer than half received the service,
the study notes, indicating the significance of knowledge, attitudes and beliefs, along with
physician behavior, to the mammography decision. Studies have repeatedly shown that a
patient's perception that her physician did not recommend a mammogram is a significant reason
for not seeking the service.
"The study underscores the need for clinicians to encourage and educate older women about
mammography and the new Medicare benefit," said Davis. "It also poses the question to policy
makers of why cost-sharing for preventive services more often falls on those most vulnerable to
preventable disease and death, but least able to share the costs."
The Commonwealth Fund is a national philanthropy engaged in health and social policy
research. Established by Anna M. Harkness in 1918, the New York City-based Fund focuses on
improving health care services, bettering the health of minority populations, advancing the well-
being of elderly people, and developing the capacities of children and young people. In 1993,
the Fund established a Commission on Women's Health to focus public attention on undervalued
and underexamined issues in women's health.
###
Date: 04/26/95 Time: 14:39
Cost a Factor in Mammograms Despite Medicare Coverage
BOSTON (AP) Even though mammograms are largely paid for by
Medicare, some women still apparently avoid having the test for
breast cancer because of the cost.
A study suggests that women are unlikely to get the screening
X-rays if they are covered by Medicare but do not have any
supplemental insurance known as Medigap policies.
While Medicare covers most of the cost of routine mammograms for
elderly women, they are still expected to pay 20 percent of the
bill, or about $12, as well as meet a $100 annual deductible.
The study found that in 1991 and 1992, the first two years
Medicare covered mammograms, only 14 percent of those with basic
Medicare got the X-rays. By contrast, about 40 percent of women
with Medigap policies got mammograms.
Most elderly women have Medigap policies, which cover the
deductible as well as the 20 percent copayment. Only about 11
percent have Medicare only.
The study, based on a review of 4,110 women, was conducted by
Dr. Jan Blustein of Columbia University. It was published in
Thursday's New England Journal of Medicine.
The study noted that cost is not the only factor in women's
decisions about mammograms and other kinds of preventive care. Even
among those for whom expense was not a factor, less than half got
mammograms.
APNP-04-26-95 1439EDT
Not most recent draft.
Dear :
Today I had the pleasure of announcing the Clinton
Administration's yearlong national mammography initiative to
increase awareness about Medicare coverage of mammograms and
their lifesaving potential for women aged 65 and older. We
launched our efforts by kicking off a "Mama-gram" campaign in
honor of Mother's Day. The campaign includes public service
announcements, a posting on my home page on the Internet, and
store displays, bill inserts and grocery store bags carrying
information about mammography and Medicare. In addition, free
"mama-grams" - - mammography reminders -- will be available at
greeting card shops and FTD florists to be slipped into a
Mother's Day card or bouquet.
We all know someone -- a grandmother, mother, sister, aunt,
daughter, friend, or in my case, a mother-in-law who has
suffered or is suffering from breast cancer. One of eight women
born in the United States will develop this terrible disease, and
the risk increases with age. That's why it is so important for
older women to get regular mammograms, along with clinical and
self breast exams.
Medicare covers mammograms for each woman beneficiary aged
65 and older every other year even if there is no reason to
believe that there is a problem with the health of the woman's
breasts. If a woman on Medicare has symptoms or if other
circumstances suggest that she may have breast disease, Medicare
will cover more frequent mammograms when they are ordered by a
doctor.
Unfortunately, Medicare data shows that fewer than 40
percent of women aged 65 and older who are on Medicare use the
mammography benefit. The Administration's goal is to provide
women aged 65 and older with the information, outreach and
support they need to motivate them to get regular mammograms
and live longer, healthier lives.
The Health Care Financing Administration is pleased to make
available to members of Congress analyses of recent Medicare
claims data on a state-by-state basis, county data, and the
"mammography kit" developed for the awareness campaign. You can
obtain this material by calling We hope that you find it
helpful.
Sincerely yours,
Hillary Rodham Clinton
Panel Questions
Questions for Senior Women
Have you had screening mammograms?
Why not?
Have you discussed mammography with your physician? Did your
doctor recommend that you get screening mammograms?
Did you know that Medicare covers screening mammography?
What concerns and fears do you have about mammography? Pain?
Embarassment? Fear of finding breast cancer?
Questions for Senior Expert/Writer
Are older women less likely to get mammograms than younger women? Are
minorities less likely than white women?
What are your views about why women don't get screening mammograms?
What are the cultural barriers?
What can we do to encourage women to get screenings mammograms? What
can we do to encourage physicians to talk to their older patients about the
importance of screening mammography?
Questions for Physicians
For those who may never of had a mammogram, can you talk about the
procedure? What do you do? What are you looking for? What do you do if
you find something?
What are the risks of breast cancer in older women? Why does the risk
increase with age?
How often should women get screening mammograms? Can you describe the
recommendations for women of different ages?
Questions for Dr. Blumenthal/Dr. Smits
Can you describe the mammography benefit provided by Medicare?
What can women do to get more information about this (and other) Medicare
benefits?
Can you describe the "Mama-gram" campaign in more detail? What will
HCFA be doing throughout the year to increase awareness and encourage
women to get regular mammograms?
How can women be sure that they are getting a high quality mammogram?
MAR-31-1995 12:09 FROM ADMIN BALTO OFFICE
TO
912024567431
P.01
THE HEALTH CARE FINANCING ADMINISTRATION's
CONSUMER INFORMATION STRATEGY
OVERVIEW
The Health Care Financing Administration's (HCFA) Consumer Information
Strategy (CIS) will help Medicare and Medicaid beneficiaries stay healthy.
Using information from a variety of sources, the new initiative encourages
greater use of health care services and assists beneficiaries in making informed
choices about health care.
Medicare and Medicaid data on the use of services and patterns of care is the
primary source of information for the initiative. Medicare alone pays more than
700 million claims a year for services to beneficiaries. Data on patterns of care
provide useful information on treatment options. Analysis of claims data also
identifies underserved localities to which special outreach efforts may be
targeted.
HCFA plans to use its network of communications with consumers and
physicians to promote use of important existing Medicare benefits and to help
consumers choose wisely among alternative treatments. The first full scale
campaign in 1994 promoted use of covered flu shots.
Screening mammography is the second campaign. Later campaigns will help
beneficiaries choose among treatment options for localized prostate cancer and
early stage breast cancer. All campaigns make use of HCFA's claims data to
highlight current practice and to monitor effectiveness.
HCFA's 1995 SCREENING MAMMOGRAPHY CAMPAIGN
Among American women, breast cancer is the most commonly diagnosed
cancer and the second leading cause of death. The incidence of breast
cancer is highest in the over-65 population served by the Medicare program.
Although Medicare covers screening mammograms for the early detection of
breast cancer, Medicare data indicate that more than 60 percent of elderly
women do not take advantage of this benefit.
In Healthy People 2000, the Department of Health and Human Services (DHHS)
set a goal that 60 percent of women in the Medicare age group should have a
mammogram every two years. The current level is 37 percent. Reasons for the
gap include lack of knowledge of the benefit, lack of physician support for
mammograms in this age group, fear of pain or harm from the mammogram,
fear of detecting an untreatable disease, modesty, and a general sense that it is
possible to be "too old" to need screening.
MHR-31-1995 11:31 FRUIT HDITIN BHLTO OFFICE
IU
912024067431
r.vz
MAMMOGRAPHY CAMPAIGN MATERIALS
0
Materials for the campaign are developed in HCFA's central office with the
collaboration of other DHHS components. HCFA has worked closely with the
National Cancer Institute, the Office of Women's Health, the Centers for Disease
Control and the Agency for Health Care Policy and Research on material
content; with the Food and Drug Administration (FDA) on issues of safety and
effectiveness of the screening; and with the Administration on Aging on the best
ways to reach the elderly.
Campaign materials include an analysis of recent claims data on a state-by-
state basis; availability of county data to interested parties; brochures in English
and Spanish that encourage screening mammography and educate Medicare
beneficiaires on the benefit; a mammography kit with newsletter articles,
posters, and magazine and newspaper "slicks".
DISSEMINATION
Dissemination for the screening mammography campaign is handled through HCFA's
ten regional offices. The basic elements of communication and outreach include:
Medicare carriers and intermediaries, working through their medical advisory
committees and newsletters, to reach the medical community and beneficiaries.
Peer Review Organizations in each State, working directly with physicians and
beneficiaries. Four PROs have already undertaken mammography promotion
campaigns and will take the lead in replicating their experiences.
Health Insurance Information, Counseling and Assistance programs funded in
each state by grants from HCFA, which use volunteers to inform beneficiaries
about Medicare.
o
Coordination with Area Agencies on Aging and State Health Departments.
COLLABORATION WITH OUTSIDE GROUPS
The success of this project is dependent on the support and enthusiasm of outside
groups. Collaboration is extensive, involving both consumer-oriented and professional
groups. Interaction takes place at many levels. For example, HCFA is working
nationally with senior groups, cancer organizations, and many provider groups. Our
regional offices and State agents are developing collaborative relationships with
beneficiary, provider, and cancer organizations throughout their own local areas.
THE WHITE HOUSE
WASHINGTON
April 20, 1995
Ms. Ruth L. Ehrenhalt
3355 Somerset Trace
Marietta, Georgia 30067
Dear Ms. Ehrenhalt:
Thank you for writing about your difficulty obtaining
payment from Medicare for the mammogram you received last March.
As you point out, Medicare pays for what are called
"screening" mammograms every other year. However, Medicare
places no limit on the number of "diagnostic" mammograms.
Because you were treated for breast cancer last year, the six-
month follow up mammograms your doctor prescribed are diagnostic,
and they will be covered by Medicare.
Many people agree that older women should receive mammograms
every year and, therefore, that Medicare should cover annual
mammograms for women aged 65 and older. However, many other
well-respected scientists and physicians believe that mammograms
performed every other year are just as effective as annual
mammograms. This issue continues to be studied. I have brought
your letter to the attention of Dr. Helen Smits, the Deputy
Administrator of the Health Care Financing Administration, which
runs the Medicare program.
Although it is clear that you are careful to take care of
yourself and your health, you may be surprised to know how few of
the women on Medicare obtain mammograms. Fewer than 40 percent
of older women on Medicare have submitted a claim for a mammogram
in the past two years. I have met with older women around the
country to talk about mammography and Medicare, and during the
next few months, I intend to continue to do what I can to help
spread the word about the importance of mammograms and to urge
older women to take advantage of this crucial Medicare benefit.
I encourage you to remind friends and family who are 65 and older
to obtain a mammogram at least every other year.
Ms. Ruth L. Ehrenhalt
April 20, 1995
Page Two
Thank you again for writing. You have my very best wishes
for your continued good health.
Sincerely yours,
Hillary
Rodham Clinton
CC: The Honorable Cynthia McKinney
THE WHITE HOUSE
WASHINGTON
April 20, 1995
Richard E. Burney, M.D.
President
American Medical Peer Review Association
1140 Connecticut Avenue N.W.
Suite 1050
Washington, D.C. 20036
Dear Dr. Burney:
Thank you for writing about the programs launched by several
of your member organizations to increase mammography use among
Medicare beneficiaries and for the invitation to your upcoming
health policy institute. Although my schedule will not permit me
to attend, I do want to commend you for your members' tremendous
efforts on behalf of our nation's older women.
As you may know, the Administration will be announcing a
national campaign to publicize the Medicare mammography benefit
and educate older women and their health care professionals about
its lifesaving potential. We will launch this effort with a
"Mamagram" campaign in honor of Mother's Day that will include
public service announcements, special events, informational
brochures, and other outreach efforts.
Thank you again for writing. I have forwarded your letter
to Dr. Helen Smits of the Health Care Financing Administration
(HCFA) and have asked her to call you to discuss ways for HCFA to
work with AMPRA members on the mammography campaign.
Sincerely yours,
Hillary Rodham Rodham Clinton Clinton
CC: Dr. Helen Smits
Remarks for Mamm. kick
eff
what you've been
doing
campaign
goal
who's involved
gov't 1 private partnership
Is Pres. going to do
PSA ?
MAR 14 '95 04:28PM
P.2
LISTENING SESSION ON MAMMOGRAMS
WHO:
First Lady
100-150 delegates (to be identified)
14 panelists
press (to be Identified)
WHAT:
Donabue-style session about mammograms
WHERE:
West end of the International Ballroom (Hilton)
sox
WHEN:
Thursday, May 4
10 a.m.-11.a.m.
8:30-9:30
HOW:
Move the IRD session originally scheduled for that section, into the center
section, which would then be divided with pipe & drape into three IRDS rather
than two.
Large platform in "front" of the room (against the air wall) for the 14-member
panel, set up with comfortable wing chairs and sofas in a U-shaped fashion
HRC
with coffee tables and plants in the background.
Dr. Smits
Dr. Blumenthal
First Lady will serve as the moderator for the session, remaining on stage,
Steve Gleason
with staff going into the audience for their participation,
Breast Surgeon
Plan for microphones for the panel and the audience.
Women from Senior
Groups- Church
Audience will sit theater-style.
Women United,
Press will sit on two-tiered risers at the back.
Older Women's League,
Natl (. on
Lorl D'Aleasio advises we contract with Freeman Decorating for furniture.
Negro Women,
AARP, Hispanic
The First Lady will require security measures comparable to the President's
(metal detectors, separate entrance, holding room, etc.). We should expect
Elderly
security activities to begin at least two hours prior to the First Lady's arrival.
Older woman writer
Sinior expert -LOU
Videotaping (professional portable unit) by USA Speakout Video, a subsidiary
Glass
of National Association for Home Care (proposed).
Admin on Aging
Many of the specific details regarding scheduling, set-up. press, etc. will not
be available until one week prior to the event, when the advance team will
contact Emily Ross.
The First Lady has held several similar sessions and will base this event on
prior sessions.
3/14/95
March 16, 1995
MEMORANDUM TO MELANNE VERVEER
FROM:
BARBARA WOOLLEY
RE:
UPDATE ON MAMMOGRAPHY CAMPAIGN
At the March 15, Mammogram Campaign meeting, the creative advisors discussed both
the Mother's Day Campaign and the general campaign. The following is a summary of
the discussion.
Creative Displays
Avis LaVelle has the creative team meeting every Wednesday to work on the
specifics. By Friday, March 17, American Greetings will have the camera ready.
copy available for the groups working with cards, button, and displays. Two to
three weeks later, all material will be ready to ship to stores. Also, the chain drug
stores will have the HHS video of the First Lady at the listening sessions available
for showing at a selected group of stores. Attached is a copy of display design.
PSAs
Five PSA scripts with boards will be presented to for your review. We also need
to reserve a block of time for taping on the First Lady's schedule when you get
back. This will also include scheduling an hour of the President's time should the
decision be made for a PSA about his mother.
Tagline
The creative advisors presented numerous taglines for considertion. Six taglines
were voted to go before focus groups to test their acceptance.
*
"What You'll Find Is Peace Of Mind."
"A Picture That Can Save Your Life. Get A Mammogram. Medicare
Covers It."
"Breast Cancer Never Retires. At 65, Get a Mammogram. Medicare
Covers It."
*
"You're Living Longer, Live Better. Get A Mammogram. Medicare
Covers It."
*
"You Always Take Care of Others, Now Take Care Of Yourself. Get A
Mammogram. Medicare Covers It."
*
"Do It For The Ones Who Love You."
Corporate Sponsors
Attached is a list of corporate sponsors participating in the campaign and their
commitment.
Senior and Provider Sponsors
Attached is a list of senior and provider organizations sponsoring the medicare
mammogram initiative. This week, HCFA has invited a number of HMO
organizations and GHAA to the White House to talk about the campaign. We
also need to bring back in the provider and senior groups to discuss the upcoming
Kickoff event at the White House.
MEDICARE MAMMOGRAPHY INITIATIVE
SPONSORSHIP ORGANIZATIONS
March 2, 1995
CORPORATE
SENIOR
PROVIDER
SPONSORS
ORGANIZATIONS
ORGANIZATIONS
Avon Products, Inc.
Church Women United
American
Hospital Association
Glamour/Hanes Hand in
Older Women's League
American College of
Hand
Ob-Gyn
American Greetings
AARP/Media Relations
American
Society of Internal
Medicine
CTFA Foundation
National Council of
American College of
Negro Women
Physicians
Hanes Hosiery
AARP(Programs
American Medical
Division of Sara Lee
Division)
Women's Association
Corporation
Estee Lauder Companies
National Hispanic*
American College of
Council on Aging
Radiology
Estee Lauder Companies
National Committee to
American Nurses
Preserve Social Security
Association
and Medicare*
J.C. Penny Company,
The National Council on
American Association of
Inc.
the Aging, Inc.*
Family Physicians
Flack and Associates
American Bar
American Cancer Society
Association,
Commission on Legal
Problems of the Elderly*
Food Marketing Institute
Catholic Charities, USA*
National Medical
Association
Shaw's Supermarkets
National Association of
National Breast Cancer
Food Marketing Institute
Area Agencies on
Coalition
Aging*
N.A.R.D.
National Association of
Komen Breast Cancer
State Units on Aging*
Foundation
CORPORATE
SENIOR
PROVIDER
SPONSORS
ORGANIZATIONS
ORGANIZATIONS
DeBor and Associates,
People's Medical
American Medical
Inc.
Society*
Association
Maidenform, Inc.
Families USA
American Academy of
Foundation*
Opthamology
NACDS
United Seniors Health
American Academy of
Cooperative*
Orthopedic Surgeons
YWCA
National Senior Citizens
Women's Health
Law Center*
Initiatives
ZENECA
The National Caucus
Pharmaceuticals
and Center on Black
Aged, Inc.*
Kmart Corporations
Medicare Beneficiaries
Defense Fund*
Revion
National Association of
Protection and
Advocacy Systems, Inc.*
The Warnaco Group*
Summit '93 Health
Coalition*
National Medical
Association/Managed
Care Project*
Center for Disability and
Health*
National Council of
Senior Citizens*
* Pending formal commitment
Prepared by: HCFA/AACRC/3-2-95
3/15/95
MEDICARE MAMMOGRAPHY INITIATIVE
CORPORATE SPONSORS
White House Conference On Aging 3,000 Delegates *Buttons
ORGANIZATION
CONTACT PERSON
TELEPHONE
BUY-
COMMITMENT
FAX #'s
IN
FTD Inc.
Luke Hasse
(810)355-6289
Y
Care Cards
*Buttons - 23,000
1-800-Flowers
Andrew Williams
(407)234-4144
?
Interested -- we need to get back to
1-800-800-SEND
President
FX:(407)234-4044
them
616 Azalea Lane
Vero Beach, Florida 32963
Society of American Florists
Peter Moran
(703)836-8700
Y
1601 Duire Street
Diana Carmen
FX:(703)836-8705
Alexandrie, VA 22314
Mary Ann Hansan
Avon Products, Inc.
Joanne Lynn Mazurki
(212) 546-7607
Y
letter
Avon's Breast Cancer Awareness
FX:(212) 456-6218
Crusade
9 West 57th St
NY, NY 10019-2683
Glamour/Hanes Hand in Hand
Linda Gordon,
(212) 447-1011
Want to know what our needs are -
140 East 81st Street, 7G
Editorial Director
FX:(212) 447-5664
they already have a program in
New York, New York 10028
place.
ORGANIZATION
CONTACT PERSON
TELEPHONE
BUY-
COMMITMENT
FAX #'s
IN
American Greetings
Maureen Stratton,
(216) 252-4942
Y
Developing point of purchase
One American Road
Director Marketing/
FX:(216) 252-6979
display.
Cloveland, OH 44144
Public Relations
"Mama"-gram slogan.
*Buttons - 30,100 Cameva ready
Shaw's Supermarkets
Margaret McEwan Vice
(202) 429-8239
Y
Dagmar requested a letter from the
Food Marketing Institute
President, Consumer
FX:(202) 429-8282
First Lady - - Debbi referred to White
800 Connecticut Ave, NW
Affairs
House.
Washington, DC 20006-2701
Dagmar Torres Farr Vice
Grocery store bag message
President, Consumer
Cards in floral shops
Affairs
CTFA Foundation
Carolyn Deaver,
(202) 331-1770
Y
Letter
1101 17th St, NW
Vice President
FX:(202) 331-1969
Suite 300
Washington, DC 20038-4702
Hanes Hoslery
Leila Meresman,
(212) 582-3025
Y
Want to know what our needs are --
Division of Sara Lee Corporation
Director Public Relations
FX:(212) 582-4343
they already have a program in
1675 Broadway
place.
New York, NY 10019
ORGANIZATION
CONTACT PERSON
TELEPHONE
BUY-
COMMITMENT
FAX #'s
IN
Estee Lauder Companies
Deborah Krulewitch, Asst
(212) 572-4430
Y
Going with reminding daughers to
767 Fifth Avenue
to the President/Vice
FX:(212) 572-4272
have their mother's get a
New York, NY 10153
President for Corporate
mammogram.
Administration
Rebecca McGreevy,
Senior Vice President of
Public Relations
J.C. Penny Company, Inc.
Carol Edwards,
(202) 862-4820
Y
1155 16th Street, NW
Lialson for the Susan G.
FX:(202) 862-4829
Washington, DC 20005
Women Foundation
Flack and Associates
Susan Flack
(202) 659-2608
Y
110 Connecticut Ave, NW
FX:(202) 293-1702
Washington, D.C. 20036
National Association of Retail Druggists
Kathryn Frances Kuhn, Vice
(703) 683-8200
Y
Letter
(N.A.R.D.)
President of Professional
FX:(703) 683-3619
205 Daingerfield Road
and Industry Relations
Alexandrie, VA 22314
Amy Carter
(703)838-2653
DeBor and Associates, Inc.
Marydale DeBor,
(301) 320-2549
Y
5004 Earlston Drive
President
FX:(301) 320-0086
Betheeda, MD 20816
ORGANIZATION
CONTACT PERSON
TELEPHONE
BUY-
COMMITMENT
FAX #'s
IN
Maldenform, Inc.
Susan Malinowski,
(212) 953-1400
Y
Requested sponsorship guidelines
so Park Ave
Vice President
FX:(212) 686-2087
for participation 2/20
New York, NY 10016
100 Retail stores will distribute our
pamphlets
National Association of Chain Drug
Phil Schnelder,
(703) 549-3001
Y
Letter?
Stores (NACDS)
Director of Public Affairs
FX:(703) 549-0771
Post Office Box 1417-D49
1. Will distribute information
Alexandria, VA 22313
Jordana Zubkoff
pamphlet.
*Button distribution
2. Computer Prompts to draw
process questions:
attention to patients in the age and
sex categories.
1. Who pays?
2. Who sends them out?
3. Some of their Drug Store Chains
3. Who pays for mailing?
will use our slogan in their own
advertizing Initiatives.
YWCA
Myrna J. Candrela,
(202) 628-3636
Y
letter
Women's Health Initiatives
Senior Program Director
624 9th Street, NW
Washington, DC 20001
ZENECA Pharmaceuticals
Lolita Thawley, Coordinator
(302)886-5135
Y
letter Has a tax exempt organization
1800 Concord Pike
Communications and
FX:(302)
to do educational projects.
Post Office Box 15437
Association Relations
Wilmington, DE 19850-5437
Karen Miller
(302)886-7713
Revion
Dr. Robert C.J. Krasner,
(212) 527-5501
?
met with Faye
Medical Services
Senior Vice President
625 Madison Ave
not part. in short term
market to youncer
New York, Ny 10022
ORGANIZATION
CONTACT PERSON
TELEPHONE
BUY-
COMMITMENT
FAX #'s
IN
The Warnaco Group
Phyllis Bonanno
(202)737-3800
?
Requested sponsorship guidelines
1455 Pennsylvania Avenue, N.W.
Staff Vice President,
FX:(202)393-1004
for participation.
Washington, D.C. 20004
International Trade
Development
Want to know how to be involved in
(Olga, Warners, Calvin
our campaign if they are not
Klein)
targeting Medicare aged women.
Kmart Corporations
Shawn Kale
(810)637-1120
Y
Very interested!
3100 West Big Beaver Rd
Vice President, Corporate
FX:(810)643-5513
Troy, Michigan 48084
and International Affairs
Wants a list of all corporate sponsors
participating in our campaign to
coordinate their efforts.
What products was older
Using Depts of Aging
women buy
Witnessing in the Delta - include
Trade show in Chicago
testimony people "we" hem
May 7-9
PSAS
PSA of older man telling
wife
March 2, 1995
Soap Opera Take shows
Medicare Mammography Campaign (MMC) Update:
Woman w/ doctor from ctty
Project goals defined:
Chase's 1995 Cal. of Events Imp dates
S-atalille - local woman w/ HRC
HHS staff (Asst. Secretary of Public Affairs, HCFA, Nat'l Cancer
Institute, PHS Office of Women's Health) met to outline both short-
term and long-term goals for Medicare Mammography Campaign.
Initial goal was to determine if one tagline could be developed
that could be used for both Mother's Day Launch and long-term
campaign. It was not possible to agree upon an all-purpose tagline
SO MMC has become a two-pronged effort:
*Mama-gram" campaign for Mother's Day
*Long-term campaign with universal tagline (to be determined)
Mother's Day
We suggest the MMC campaign be launched with a WH press conference
pegged to the start of the WHCOA on or before May 3rd. Event will
be opportunity to unveil "Mamagram" concept for Mother's Day and
outline goals of a long-term campaign.
We decided that mock "mamagrams", card inserts and a small supply
of buttons and point-of-sale displays would be the most feasible
strategies for the short-term blitz. The supply of buttons could be
distributed to point-of-sale personnel/vendors and in registration
kits for participants at the White House Conference on Aging with
display cards at WHCOA registration booths and in stores and
florist shops.
HCFA has made contact with most of the targeted distributors for
the Mother's Day materials - - the greeting card, chain drug store,
and food marketing groups. Efforts are also being made to follow up
with the fourth target, the florists.
The American Greeting Card people like the idea of small card
inserts and will print and distribute them pro bono if we deliver
camera-ready art-work by April 1. We agreed that the "mama-gram"
component of the MMC should have a broader appeal to women of all
ages while the supporting copy can highlight the increasing risk of
cancer for older women.
The drug and food groups are also interested in participating in
other ways, including shopping bag messages and messages on drug
inserts as pharmacy orders are filled.
-2-
Beyond Mother's Day
Creative Team Takes Shape:
*Leslie Rose/Frank Mankiewicz, Team Leaders, Hill and
Knowlton, Wash. D.C.
*Sheila Raviv, Burston-Marsteller, Washington, D.C.
*Tamar Small, Biologix/HealthCare Marketing Communications,
Philadelphia, Pa.
*Vicki Thomas, Mature Marketing Specialists, Westport, Conn.
*Melinda Schnare, Walcoff and Associates, Fairfax, Va.
*Helen Harris, Helen Harris Associates (senior marketing
consultants), Westport, Conn.
Hill and Knowlton has agreed to lead the creative team that will
develop the theme and PR materials for long-term campaign.
Together with HHS team, creative team will explore avenues for
participation for all the non-governmental and corporate partners
who have agreed to participate in MMC beyond Mother's Day kickoff
activities.
Follow-up meeting will involve HHS staff and creative team to give
them a substantive overview of the mammogram issue and share
research that will form basis of theme/copy.
First task is to develop tagline that will be universal to all
brochures, posters, psa's, wallet cards and collateral materials
such as bumper stickers, book marks, buttons, pens, refrigerator
magnets, etc.
Long-term campaign will capitalize on various calendar holidays
such as Grandparent's Day, and Breast Cancer Awareness
Month (October) as well as various conventions, meetings and
gatherings of older Americans such as Senior Olympics (May 17th-
29th in San Antonio, TX) and its local games throughout the country.
(partial calendar attached)
Governmental Support for Campaign
HS/ASPA office is co-ordinating interagency support through HCFA,
National Cancer Institute and the Office of Women's Health.
Regional outreach plans have been developed and NCI will expand its
current breast cancer awareness campaign (targeted to age 50 and
over) to focus on the over 65 population as a special target
audience as it does for minority and underserved women.)
January
1995
July
S M T W T F S
S M T W T F S
1 2 3 4 5 6 7
1
8 9 10 11 12 13 14
Grandparents' Year
2 3 4 5 6 7 8
9 10 11 12 13 14 15
15 16 17 18 19 20 21
16 17 18 19 20 21 22
22 23 24 25 26 27 28
23 24 25 26 27 28 29
29 30 31
May
July
30 31
1 OLDER AMERICANS' MONTH
30 National Medical Association Conference
February
2 White House Conference on Aging
31 National Medical Association Conference
August
S M T W T F S
3 White Houe Conference on Aging
S M T W T F S
1
2
3
4
4 White House Conference on Aging
August
1 2 3 4 5
5 White House Conference on Aging
5 6 7 8 9 10 11
17 Senior Olympics
1 National Medical Association Conference
6 7 8 9 10 11 12
12 13 14 15 16 17 18
18 Senior Olympics
2 National Medical Association Conference
13 14 15 16 17 18 19
19 Senior Olympics
3 National Medical Association Conference
19 20 21 22 23 24 25
20 Senior Olympics
21 American Hospital Association Conference
20 21 22 23 24 25 26
26 27 28
21 Senior Olympics
22 American Hospital Association Conference
27 28 29 30 31
22 Senior Olympics
23 American Hospital Association Conference
23 Senior Olympics
March
24 Senior Olympics
September
September
S M T W T F S
June
S M T W T F S
10 GRANDPARENTS' DAY
1
2
3
4
21 American Academy of Family Physicians
1 2
5 6 7 8 9 10 11
18 Group Health Association of America
Conference
3 4 5 6 7 8 9
Conference
22 American Academy of Family Physicians
12 13 14 15 16 17 18
American Medical Association Conference
Conference
10 11 12 13 14 15 16
19 20 21 22 23 24 25
19 Group Health Association of America
23 American Academy of Family Physicians
17 18 19 20 21 22 23
Conference
Conference
26 27 28 29 30 31
American Medical Association Conference
24 American Academy of Family Physicians
24 25 26 27 28 29 30
20 Group Health Association of America
Conference
April
American Medical Association Conference
October
S M T W T F S
21 Group Health Association of America
October
Conference
S M T W T F S
1
American Medical Association Conference
1 BREAST CANCER AWARENESS
1 2 3 4 5 6 7
2 3 4 5 6 7 8
22 American Medical Association Conference
MONTH
23 American Medical Women's Association
8 9 10 11 12 13 14
9 10 11 12 13 14 15
22 American College of Surgeons Conference
Conference
16 17 18 19 20 21 22
23 American College of Surgeons Conference
15 16 17 18 19 20 21
24 American Medical Women's Association
24 American College of Surgeons Conference
23 24 25 26 27 28 29
Conference
22 23 24 25 26 27 28
25 American College of Surgeons Conference
30
25 American Medical Women's Association
26 American College of Surgeons Conference
29 30 31
Conference
27 American College of Surgeons Conference
26 American Medical Women's Association
May
Conference
November
S M T W T F S
S M T W T F S
1
2
3
4
5
6
July
1
2
3
4
7 8 9 10 11 12 13
20 National Association of Area Agencies on
5 6 7 8 9 10 11
14 15 16 17 18 19 20
Aging
12 13 14 15 16 17 18
21 National Association of Area Agencies on
21 22 23 24 25 26 27
Aging
19 20 21 22 23 24 25
28 29 30 31
22 National Association of Area Agencies on
26 27 28 29 30
Aging
23 National Association of Area Agencies on
June
Aging
December
S M T W T F S
24 National Association of Area Agencies on
S M T W T F S
Aging
1
2
3
25 National Association of Area Agencies on
1
2
4 5 6 7 8 9 10
Aging
3
4
5
6
7
8
9
26 National Association of Area Agencies on
10 11 12 13 14 15 16
11 12 13 14 15 16 17
Aging
17 18 19 20 21 22 23
18 19 20 21 22 23 24
27 National Association of Area Agencies on
Aging
24 25 26 27 28 29 30
25 26 27 28 29 30
29 National Medical Association Conference
31
3/2/1995
THE WITNESS PROJECT
MISSION STATEMENT:
The Witness Project is a culturally-sensitive community-based cancer education program
through which cancer survivors and lay health educators increase awareness, knowledge,
screening, and early detection behaviors in the rural and lower income African-American
population in an effort to reduce the mortality and morbidity from cancer.
In church, people witness to save souls.
At the Witness Project, they witness to save lives!
STATEMENT OF NEED:
Because of Arkansas's extreme rural nature, low per capita income, high percentage of citizens
over age 65, and high regional concentration of African-Americans in the Delta, cancer
education and screening is a significant state need. Arkansas is one of three states identified
by the Lower Mississippi Delta Development Commission as being among the poorest and
most economically depressed in the nation. These counties average 30% African-American
females and have 21% of families living below poverty and 12% of adults with less than a
ninth grade education. These counties have limited numbers of primary care and preventive
health services and high age-adjusted mortality rates for breast cancer.
African-Americans have the highest overall age-adjusted rates of cancer incidence and mortality
of any United States population group. Despite a somewhat lower incidence rate, the five-year
survival rate for African-American women with all stages of breast cancer is notably lower
than the rate for white women. Surveys consistently find that African-Americans are less
knowledgeable than whites about most cancer-related issues. They often delay seeking health
care, so their cancers are often diagnosed at later stages. Although screening mammography
rates continue to rise in the general population, minority and low-income women have
increasingly lower utilization rates.
To be effective, cancer education messages must meet the needs of individuals at all literacy
levels. Low-income and low-literate populations have not been adequately reached with
communication strategies by health educators and cancer control providers. Although a large
number of Americans, particularly low socioeconomic and African-American populations are
functionally illiterate, typical printed cancer education materials are written at the 10th or 11th
grade reading level.
The Witness Project
PRELIMINARY WORK:
The Witness Project is a health education program designed to meet the specific cultural,
educational, knowledge, and learning style levels of rural, underserved African-American
women. Rural and lower income African-American women who have had early stage breast
and cervical cancer educate other women about the importance of early detection by
"witnessing," or talking about their cancer experiences, stressing the importance of screening
practices and answering questions about their personal experiences, fears, and concerns.
Developed in 1990 by Dr. Deborah Erwin of the Arkansas Cancer Research Center and Dr.
Thea Spatz of the University of Arkansas at Little Rock, the Witness Project is presented in
cooperation with the American Cancer Society, Arkansas Department of Health, and numerous
local churches and community groups. Originally funded by a Title XX grant from the
Arkansas Department of Health in 1991, the Witness Project was the first program in Arkansas
to target socioeconomically disadvantaged women through African-American churches. Data
from the pilot project was published in 1992.
From 1992 through 1994, research on the Witness Project has been supported by the Susan G.
Komen Breast Cancer Foundation. This research validated that the program is culturally-
sensitive and is accepted and supported by African-American church groups and communities.
It is effective in drawing low income, less educated, rural African-American women to
participate. Some 45% of the program participants have less than a 12th grade education; 52%
reported annual incomes under $10,000. A striking example of the need for increasing
education and awareness within this population is the fact that when asked, "Have you ever
talked with other women about breast cancer?", the majority (54%) reported "No". Fifty-five
(55%) percent of the women have never had a mammogram, and only 30% reported that their
doctor had ever recommended one. Thirty percent (30%) of the women reported they never
had a breast examination by a physician.
The Witness Project received the National Honor Citation from the American Cancer Society
in 1991. Locally, the program received the Wilowe Institute Achievement Award in 1993.
CURRENT ACTIVITIES:
Programs: Witness Project programs are presented to groups of women in churches and
community centers across Arkansas. Rural and lower income African-American women, who
have had early stage breast or cervical cancer, tell about their experiences to encourage and
educate other women about the importance of early detection. The program is designed to
empower women to prioritize their own health care needs and to counter the fear and fatalism
so often found among minority and lower income populations. As of April 1994, almost 400
women have attended witness programs in Arkansas.
The Witness Project
During a program session, the role models "witness" by talking about their experiences with
cancer, stressing the importance of cancer screening, and answering any questions about their
personal experiences, fears and concerns. Witnessing is done by a minimum of two and a
maximum of five survivors to small audiences of up to 25 participants. At least two witnesses
participate in each session to avoid the appearance of a "token" survivor. The content
addresses the fears and beliefs many women hold about cancer, demonstrates that the diagnosis
of cancer is neither a death sentence nor a punishment, and provides participants with accurate,
personal information about cancer, early detection and treatment methods. Breast self-
examination, using ethnic breast models, is taught at each session.
Mammograms: Through the Witness Project, the Susan G. Komen Foundation provides free
mammograms for women who may not be able to afford them. When an abnormal
mammogram result is obtained, the woman is notified of the need to see a physician. If she
wants to see a local physician but can not afford one, she is referred to the Arkansas Health
Care Access Foundation, Inc. which provides a toll-free telephone number and referral to a
volunteer primary care physician in her area. If she does not have a local physician and she
wants to see a surgical oncologist, she is referred to the Arkansas Cancer Research Center at
the University of Arkansas for Medical Sciences, which provides care regardless of race,
religion or ability to pay. If she is hesitant to return for follow-up or frightened by the
"abnormal results", the role models act as a support group and encourage her to seek care. As
of April 1994, 77 vouchers have been distributed to women directly; 35 have been used.
Another 63 have been distributed to local physicians; 18 have been used. Of these 53
mammograms, 11 (21%) were abnormal and 1 breast cancer was diagnosed.
Exhibits: A series of 12 black and white photographs of Witness Project role models, together
and individually, were produced by local photographer/artist Andrew Kilgore with the support
of the Komen Foundation and American Cancer Society. These framed photographs and a
description of the Witness Project have been exhibited twice, and both exhibits have generated
interest in the program. One exhibit was at the Arkansas Leadership Summit in October 1993,
the first of 26 NCI-sponsored regional breast cancer education summits. These photographs
are used as recruitment exhibits at various community and church sites to stimulate cancer
survivors and other local women to become involved in this outreach program.
Video: A brief (8-12 minute) professionally produced descriptive video is being developed this
year. This video will present the Witness Project as a cancer education outreach program for
African-American women, featuring the women who serve as role models and lay health
educators and describing the goals of the program. The video will be available to "speak" at
outreach education programs when witness faculty members are not available. The
development of the video has a process evaluation component incorporated through the focus
groups, review by potential viewers, and evaluation by the adult education staff at the
University of Arkansas at Little Rock. It will also be used to recruit and train additional role
models. The Witness Project brochure will accompany this video (see attached copy).
The Witness Project
FUTURE PLANS:
Witness Instructional Training Program: A Training Program will be established to develop
and implement an effective cancer education curriculum, recruit and train more role models and
lay health educators, and make this training program available by developing videos and a
training manual for use by cancer centers, community groups, the American Cancer Society,
Cancer Information Service, churches and other organizations.
Instructional Curriculum: A training curriculum will be compiled in a program manual and
packaged with one or more videos, and the package will be offered to other cancer centers,
health departments, or organizations who desire to implement similar early detection and
educational programs in their regions. Through training the current role models and lay health
educators, Drs. Spatz and Erwin have begun development of a curriculum which addresses the
adult education needs of lower income and less educated African-American women. This
training is an interactive process, with minimal reading and academic requirements. The
program manual will include recruitment methods, instructions for setting up an outreach
training program, a curriculum outline for each training session (including educational
objectives, slides and text for a training program leader), suggested supplemental materials for
adult learners with minimal reading skills, evaluation tools, references, and a resource list.
Recruitment & Training: Although the successful Witness Project enjoys excellent support
and cooperation from the women and churches in the participating Delta counties, the time and
labor intensity of the program, as well as requests from other states and facilities, have created
the need for an educational training component. By training more witnesses in a systematic
manner, the Witness Project can be extended to women in additional underserved counties.
Like the Witness Project educational activities, recruitment and training will be conducted
through African-American churches. Specific criteria and application forms will provide a
basis for selection of trainees. Recruitment will be accomplished through ongoing witness
education sessions, personal contacts, the photographic exhibit, and some local advertising.
Training sessions will be scheduled by consensus of each group and will be held locally in
each of the counties. Two different types of training - role model and lay health educator -
will provide the directors with substantive experience to develop the instructional curriculum
package. The training program for the role models is based upon the theory that having lower
income, African-American women who have had breast cancer provides leadership from
individuals with cultural patterns, values, experiences, and problems similar to the audience
they are trying to reach. These women provide unequivocal, positive examples of the
effectiveness of early screening and diagnosis. Likewise, lay health educators of the same race
and cultural background as the desired audience can encourage and empower women by
addressing attitudes, norms and values regarding breast self-examination, pap tests, and
mammography. The 12-hour training program is designed to enhance these qualities.
The Witness Project
VOLUNTEER & PROFESSIONAL STAFF:
To date, 10 African-American women who have survived breast or cervical cancer have been
trained as role models and lay health educators. Five women are from urban Pulaski County
and five are from the Arkansas Delta. These experienced women conduct the program sessions
and serve as the Steering Committee for the Witness Project.
As project directors, Drs. Deborah Erwin and Thea Spatz are responsible for all scientific and
administrative aspects. Other members of the professional staff include:
Ms. Tricia Butler, Project Coordinator
Ms. Jody Brennan, Video Development Coordinator
Dr. Craig Stotts, Evaluation Coordinator
Ms. Dianne Colley, Outreach Coordinator
Ms. Linda Deloney, Educational Development Specialist
Dr. Wilma Diner, a Diplomate of the American Board of Radiology, and Dr. Suzanne
Klimberg, a surgical oncologist who specializes in breast cancer, provide clinical expertise to
the project. As African-Americans, Ms. Colley and Ms. Butler provide minority representation
for the research team.
ADDITIONAL INFORMATION:
The Witness Project is supported by the following organizations:
Susan G. Komen Breast Cancer Foundation
Arkansas Cancer Research Center at the University of Arkansas for Medical Sciences
Delta Health Education Center
University of Arkansas at Little Rock
American Cancer Society
Arkansas Department of Health
National Black Leadership Initiative on Cancer
For more information on the Witness Project, contact the Cancer Education Department at the
Arkansas Cancer Research Center by calling 501-686-8801.
Name
Organization
Phone
Debbi Oxenreider
HCFA (202)260-8851
Px(202)(401-7438
nyRNA CANDREIA
yuca of the U.S.A. (202)628-3636
Kerrie Wilson American Cancer Society 202-546-4011
Joyce Agunbiade Nation Council of Heave Women 202-628-0015
Worth Shore USA
202-338-9380
Satt FREY
Asher idea line is League 202) 783 -6686
Tontali
HCEA
410-966-4709
Sam Shekm
HCFA
(202) 690 - 5727
Jennifer klein
uffice is inc First Lady (201)456 2577
ROSEMARY A. LOCKE
Y-ME
(703)241-8628
(703)536-4592 F
202 401 4541
Moya Berioit Thompson
DHHS/AOA
4017741 fax
Ann Delorey
Church of United 2/544-8747
pe Ewin National Councilof Senior Citizens 624-9534
(fax) 624-9595
Heleo S.. t,
(Aver)
Name
ORG
Phone
Anne Marie Hummel HCFA
202-690-6113
BAREARA DIVVER
NCOA
202-479- 6605
Ted Bobrow
AARP Communications Division 202-434-2560 far 434-2588
Lisa Rubenxein
AARP Programs Decision 202 434-2248
Isela Castillo
on behalfof
NaH. Assoc. For Hisp. Elderly (213) 487-1922
Carmela G. Lacay O/CEO
Holman. - Pape for:
Ginger Pape
3
Susan 6. Komen preast
202/293-9360
Caucer Foundation
Withdrawal/Redaction Marker
Clinton Library
DOCUMENT NO.
SUBJECT/TITLE
DATE
RESTRICTION
AND TYPE
001. memo
Sandee Katz to Jennifer Klein re requested information [personally
04/04/1995
b(6)
identifiable information] [partial] (1 page)
COLLECTION:
Clinton Presidential Records
First Lady's Office
Jennifer Klein
OA/Box Number: 13530
FOLDER TITLE:
Mammogram Event/WHCOA [White House Conference on Aging]
2014-0536-S
kc1560
RESTRICTION CODES
Presidential Records Act - |44 U.S.C. 2204(a)]
Freedom of Information Act - 15 U.S.C. 552(b)]
P1 National Security Classified Information [(a)(1) of the PRA]
b(1) National security classified information |(b)(1) of the FOIA]
P2 Relating to the appointment to Federal office [(a)(2) of the PRA]
b(2) Release would disclose internal personnel rules and practices of
P3 Release would violate a Federal statute |(a)(3) of the PRA|
an agency |(b)(2) of the FOIA]
P4 Release would disclose trade secrets or confidential commercial or
b(3) Release would violate a Federal statute |(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
b(4) Release would disclose trade secrets or confidential or financial
P5 Release would disclose confidential advice between the President
information |(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
b(6) Release would constitute a clearly unwarranted invasion of
P6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
b(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed
b(8) Release would disclose information concerning the regulation of
of gift.
financial institutions [(b)(8) of the FOIA]
PRM. Personal record misfile defined in accordance with 44 U.S.C.
b(9) Release would disclose geological or geophysical information
2201(3).
concerning wells |(b)(9) of the FOIA|
RR. Document will be reviewed upon request.
01/01/95 08:17
110 328 0538
Z
001
[001]
University Mary and
Mr.tical Center
UNIVERSITY OF MARYLAND
REACH OUT FOR HEALTH PROGRAM
CANCER CENTER
Mammography Screening Service
401 West Redwood Street, Suite 206
Daldmore, Maryland 21201-1703
1 800 787-0506
TO:
JENNIFER KLEIN
Uffice of the First Lady
Fax # 202-456-2878
FR:
SANDEE T.. KOLODNY KATZ
REACH OUT FOR HEALTH PROGRAM
DA:
April 4, 1995
Dear Jenniter,
As you have requested, here is the information:
Sandee L. Kolodny Katz, R.N.
Program Director
12 Stonehenge Circle, #10
Baltimore, Maryland 21208
(Home) - 410-602-0082
(Office) - 410-328-5395/ 800-787-0506
(b)(6)
See you in May.
Gandee
Dear Friends:
On May 1, in honor of Mother's Day, May 14, and Older
Americans Month, the Clinton Administration will launch a
nationwide "Mamagram" campaign. Our goal is to increase
awareness about Medicare coverage of mammograms and their life-
saving potential for women over the age of 65. Mammograms can
detect breast cancer early -- in time for successful treatment --
yet only 37 percent of women over 65 take advantage of the
mammography benefit offered by Medicare.
During the past several months, I have travelled around the
country listening to older women share their experiences,
feelings and fears about mammography and breast cancer. I have
learned that, with information, outreach, and support, women over
65 will get mammograms to help them live longer, healthier lives.
I want to thank you all for your participation in our
efforts so far, and I look forward to continuing our productive
partnership throughout the "Mamagram" campaign. The
Administration will work with local aging agencies, state health
departments, and private organizations to spread the word about
mammography. Public service announcements, special events,
informational brochures, and other outreach efforts will also be
a part of the campaign. Together, we can succeed in increasing
the use of the powerful weapon of mammography in the fight
against breast cancer among our nation's older women.
Sincerely yours,
Hillary Rodham Clinton
Dear FMI Member:
On May 1, in honor of Mother's Day, May 14, and Older
Americans Month, the Clinton Administration will launch a long-term,
nationwide "Mamagram" campaign. Our goal is to increase
awareness about Medicare coverage of mammograms and their life-
saving potential for women over the age of 65. Mammograms can
detect breast cancer early -- in time for successful treatment --
yet only 37 percent of women over 65 take advantage of the
mammography benefit offered by Medicare.
During the past several months, I have travelled around the
country listening to older women share their experiences,
feelings and fears about mammography and breast cancer. I have
learned that with information, outreach, and support women over
65 will get mammograms to help them live longer, healthier lives.
e
I hope you will join us in our campaign. The Administration
will work with state and local governments and private
organizations to spread the word about mammography. Public
service announcements, special events, informational brochures,
and other outreach efforts will also be part of the campaign. By
using the enclosed materials on your advertisements, flyers,
grocery bags and in-store promotions, you can provide vital
information and help send this life-saving message to your
customers.
Sincerely yours,
Hillary Rodham Clinton
03/31/95
19:09
002
Dear FMI Member:
longterm
In honor of Mother's Day, May 14,
Two weeks before Mother's Day, on May 1 1995 L the Clinton
$
Administration will launch a nationwide "Mamagram" campaign. Our
goal is to increase awareness about Medicare coverage of
mammograms and their life-saving potential for women over the age
of 65. Mammograms can detect breast cancer early -- in time for
successful treatment -- yet only 37 percent of women over 65 take
advantage of the mammography benefit offered by Medicare.
During the past several months, I have travelled around the
country listening to older women share their experiences,
feelings and fears about mammography and breast cancer. I have
learned that, with information and outreach, women over 65 will
get mammograms to help them live longer, healthier lives.
state and local governments
I hope you will join us in our campaign. The Administration
will work with lecal aging agencies, state health partments,
and private organizations to spread the word about mammography through
public service announcements, special events, informational
brochures, and other outreach efforts. By using the enclosed
materials on advertisements, flyers, grocery bags and in-store
promotions, you can provide vital information and help send this
life-saving message to your customers.
Sincerely yours,
Hillary Rodham Clinton
03/31/95 19:09
003
Same changes additional +
as
Dear Friends:
Two weeks before Mother's Day, on May 1, 1995, the Clinton
Administration will launch a nationwide "Mamagram" campaign. Our
goal is to increase awareness about Medicare coverage of
mammograms and their life-saving potential for women over the age
of 65. Mammograms can detect breast cancer early -- in time for
successful treatment -- yet only 37 percent of women over 65 take
advantage of the mammography benefit offered by Medicare.
During the past several months, I have travelled around the
country listening to older women share their experiences,
feelings and fears about mammography and breast cancer. I have
learned that, with information and outreach, women over 65 will
get mammograms to help them live longer, healthier lives.
so far
"Mamagram"
I want to thank you all for your participation in our
efforts to date, and I look forward to continuing our productive
partnership throughout the Administration's outreach campaign.
The Administration will work with local aging agencies, state
health departments, and private organizations to spread the word
about mammography public service announcements, special events,
informational brochures, and other outreach efforts. Together,
we can succeed in increasing the use of this powerful weapon in
the fight against breast cancer among our nation's older women.
Sincerely yours,
Hillary Rodham Clinton
04/04/95
08:48
410 328 0538
Z
X
002
®
acr
American College of Radiology
The Mammographic Imaging Services of
University of Maryland Medical System - MOBILE
Baltimore, MD
were surveyed by the
Committee on Mammography Accreditation of the
Commission on Standards and Accreditation
The following unit was approved:
GE Seno 600T 1991
Accredited from:
March 1, 1995 through March 1, 1998
Stephen a. Feig , M.D.
CHAIRMAN, COMMITTEE ON MAMMOGRAPHY ACCREDITATION
PRESIDENT, AMERICAN COLLEGE OF RADIOLOGY
MAP 05128 01
J. Cuncer Education. Vol. 7. No. 4. pp. 311-319, 1992
0885-8195/92 $5.00 + .00
Printed in the U.S.A. Pergamon Press Ltd.
© 1992 American Association for Cancer Education
DEVELOPMENT OF AN AFRICAN-AMERICAN ROLE
MODEL INTERVENTION TO INCREASE BREAST
SELF-EXAMINATION AND MAMMOGRAPHY
DEBORAH O. ERWIN, PhD*; THEA S. SPATZ, EdD, CHESt; and
CAROLYN LAZARO TURTURRO, PhD, CHESI
Abstract - Minorities and indigent populations have low participation rates in breast cancer educa-
tion and screening programs, and suffer from higher morbidity and mortality. Attitudes, norms,
and values of such populations are best addressed by breast cancer patients of the same race and
cultural background who serve as role models. This article describes the development and pilot study
of an intervention program using role models as part of a "Witness" presentation. Programs were
held in participants' local African-American churches and community centers. The organization of
the program was based on an educational model (4MAT) that identified learning styles and brain
hemisphere dominance. Preliminary results with 78 African-American women indicate that the pro-
gram design is effective in reaching low-income, less-educated African-American women who did
not believe themselves to be at high risk for breast cancer. Three-month follow-up demonstrated
a significant increase in the practice of BSE and 19% had a mammogram.
INTRODUCTION
screening procedure. During the period 1950-
1967, significant variations were found in can-
Mammography is an early detection method
cer incidence and survival between Caucasians
that reduces cancer mortality, particularly for
women 50 years of age and older 1,2 Among
and African-Americans.⁶ The five-year sur-
vival rate for cancer of the breast is 75% for
African-American women in the United States
caucasian Americans, and 63% for African
over age 40, national studies report as many
Americans 7,8 Although the difference in
as 83% have heard of mammography and
59% have had a mammogram. 3 Regional spe-
mortality rates (from cancer and from other
causes) is large, there are no widely accepted
cial-population studies, however, show mam-
explanations.
9,10
mogram rates that are half as high as the
national rates. 4,5 Also, of the African-Amer-
A partial explanation for the difference in
cancer survival rates of African Americans and
ican women who have had a mammogram, the
majority have had only one. 3 Often, these
caucasian Americans may be socioeconomic
status rather than ethnicity.
7,10,11
Socioeco-
one-time mammograms may be for diagnos-
nomic factors affect access to medical care,
tic purposes and are not part of a routine
both for early diagnosis and treatment. Lower
income and the lack of health insurance may
This research was supported by a Health Education
Training Center Grant for the Delta Health Education
act as barriers to the use of screening programs
Center; and an Arkansas Department of Human Services,
like mammography.
Title XX Grant (DHS 1337).
Unfortunately, the number and proportion
Division of Surgical Oncology, University of Arkan-
sas for Medical Sciences, Associate Director for Educa-
of Americans below the poverty level is in-
tion, Arkansas Cancer Research Center, Little Rock,
creasing. Currently 16% of Americans (39
Arkansas.
million) live below the poverty level ($11,200
+Department of Biology, University of Arkansas at Lit-
tle Rock, Little Rock, Arkansas.
yearly for a family of four). 7,12 The propor-
Department of Psychology and Gerontology, Univer-
tion of Americans without adequate health in-
sity of Arkansas at Little Rock, Arkansas.
surance has grown as well, with the largest
Reprint requests to: Deborah O. Erwin, PhD., CTR,
Arkansas Cancer Research Center, 4301 W. Markham,
percentages among African-Americans and
Mail Slot 623, Little Rock, AR 72205.
Hispanics.
12 African-Americans are less likely
311
312
D. 0. ERWIN et al
to recognize cancer risks and the need for early
can representatives act 25 health educators or
screening.
13-15
These women are also at greater
informants.
28
risk for late diagnosis of breast cancer. 16,17
It is hypothesized that breast cancer survi-
Programs that specifically address African-
vors of the same race and cultural background
American and lower-income women, who
can encourage and empower other women to
have low participation levels in cancer educa-
practice methods of breast cancer detection by
tion and cancer screening programs, have been
addressing existing attitudes, norms, and val-
lacking. 18-21 Better, more specific programs
ues regarding BSE and mammography. The
are needed. The role model intervention pro-
role models serve as living proof of the effi-
gram described in this paper is a culturally sen-
cacy of breast cancer treatment; they are peo-
sitive methodology which addresses the specific
ple with whom other women can identify.
health beliefs and attitudes, as well as issues
This role model intervention targets Afri-
of locus of control, and the value placed on
can-American women in Arkansas. The Ar-
health by African-American women.
kansas 1990 census was 2,350,725 (82.6%
Attitudes, social norms and values were all
caucasian; 16.3% African-American). 29 With
found to be significant direct predictors of in-
the Arkansas average per capita income of
tentions and participation in mammography
$12,216 in 1988, only residents of Mississippi
screening, in a study of 946 women aged 40
and West Virginia make less money. 30 Rural
and above. 22 Health, attitudes, and behaviors
Arkansans, with an average income of $11,324,
are also influenced by the value that an indi-
earned even less and many of these people do
vidual places upon health. 23 In one locus-of-
not have health insurance. Many areas of Ar-
control investigation, respondents who thought
kansas are sparsely populated, and there are
that health was not a matter of luck reported
few physicians and health-care facilities. The
preventive health actions both prospectively
proportion of African Americans in the lower
and retrospectively. 24 Although there was no
Mississippi River Delta counties ranges from
direct relationship between sense of control
43% to 58% 29
and breast self-examination (BSE), the per-
ceived efficacy of breast cancer treatment was
METHODOLOGY
associated with health locus-of-control mea-
sures. Although Bloom demonstrated that in-
The authors, middle-class caucasians, rec-
come was not a predictor of mammography
ognize a limited credibility with the target
utilization in her research sample, the data did
population. Previous efforts with this special
indicate that the African-American women
population were not effective. 31 Information
who perform regular breast self-examination
gathered from key informant interviews, par-
(BSE) are more likely to obtain mammo-
ticipant observation, and focus groups of ru-
grams 25 Therefore, introducing BSE and the
ral and urban African-American women led
effectiveness of early diagnosis should lead
to the development of a role model interven-
to a subsequent increase in mammography
tion program called "Witnessing." The term
screening among African-American women.
Witnessing is familiar to many southern Afri-
When people share similar cultural pat-
can-American women and is derived from be-
terns, values, experiences, and problems, they
haviors noted within the church. Witnessing
are likely to feel more comfortable and under-
occurs in fundamentalist Christian churches,
stand each other better. 26 Secondly, race is a
especially in the south, when an individual
relevant factor to consider when determining
shares with the congregation a personal reli-
health care utilization even when socioeco-
gious experience. A person witnesses (testifies)
nomic class is not. 27 Unfortunately, there are
by explaining how his/her life has changed
few African Americans in the medical profes-
through a particular experience. A witness
sion and allied health fields. One solution to
might describe how he/she overcame some
this problem may be to have African-Ameri-
major hardship or how he/she is able to live
Role model intervention
313
with some continuing hardship. The intended
uses discussion and interaction. Their favor-
effect of witnessing is to help others within
ite question is "Why?" The first step, right
the congregation who are struggling with se-
mode, is to connect past experience with the
rious problems of life and to encourage behav-
new, thereby imposing personal meaning on
ior that supports the religious doctrine of that
what is learned. The second step, left mode,
church.
is to examine the connection (ie, personal
Witnessing in the role model intervention
experiences and discussion within witness
program focuses on a woman's recognition
session).
and discovery of a breast lump, the treatment
Type 2 learners perceive by thinking/rea-
process, her personal philosophy regarding
soning, and they process by watching/reflect-
survival, and the benefits of early detection.
ing. Type 2 learners emphasize knowledge and
The intended effect is to empower others to
prefer the informational method of learning.
take responsibility for their health and to prac-
Their favorite question is "What?" Step three,
tice early detection behaviors. Specifically, the
right mode, is to imagine the concept. Step
role models challenge the excuses women use
four, left mode, is to define the concept with
for not performing BSE or having mammo-
facts and information (ie, BSE/mammogra-
grams. Direct educational methods are the
phy literature).
most effective means of communication in an
Type 3 learners perceive by thinking/rea-
ethnic minority community, particularly when
soning and they process by doing/trying. Type
the person making the contact is culturally and
3 learners emphasize application and prefer
socioeconomically similar. 32
using the coaching method of learning. Their
An essential element of the witness role
favorite question is "How does it work?" The
model intervention program design is to appeal
fifth step, left mode, the learner tests concept
to all individual learning styles. With lower-
implications. The sixth step, right mode, is
income, less-educated audiences who do not
used to elaborate and reconstruct the defined
traditionally respond to orthodox, didactic
concepts (ie, practice with breast models).
instruction, it is essential to involve more right-
Type 4 learners perceive by sensing/feeling
brain activity. The organization of the witness-
and they process by doing/trying. Type 4
ing element of the program is based on a
learners emphasize personal adaptation and
theoretical educational model, the 4MAT®
prefer using the self-discovery method of
System, which has been effective in another
learning. Their favorite question begins with
breast health education program³³.³⁴ and in
"If?" The last two steps, left mode then right,
other educational settings. 35
are used to evaluate and modify the concepts
The 4MAT® System is an educational pro-
in order to integrate new connections (ie, shar-
cess presented as a sequential cycle of learn-
ing with significant others).
ing that is based on learning style and brain
For example, positive, dramatic, real-life
dominance. Each of four learning styles is ad-
stories, presented by individual role models is
dressed in the cycle with right and left hemi-
a right-brain, quadrant-one activity in the
sphere mode techniques applied within each of
4MAT® System. Both the witnessing session
the four learning styles, creating eight steps.
and the BSE instructional sessions address the
Figure 1 illustrates the 4MAT System. Each
eight steps. This assures better attention to the
learning style has a distinct combination of
educational material and provides for better
perceiving and processing information, a pre-
recall of factual information. 33
ferred method of learning, and a favorite
Five African-American women who have
question.
survived breast cancer were invited to join
Briefly, Type 1 learners perceive by sensing/
the authors as an advisory group and act as
feeling, and they process by watching/reflect-
role models after being interviewed in their
ing. Type 1 learners emphasize personal mean-
homes. The women were all Stage I breast
ing, and their preferred method of learning
cancer patients, who either had a modified
314
D.O. ERWIN et al
Sensing/Feeling
[Right Model)
(Right Model]
H. Share the
A.
unique
Create an
learning
experience
with others
that engages
[Len Model]
personal
meaning
G. Analysis of
results
B. Analyze the
[Iepow
Type 4:
Type 1:
experience
IF?
WHY?
Doing
Watching
F. Personal
Type 3:
Type 2:
adapation
HOW?
WHAT?
C. Integrate the
unique to
experience and
individual
analysis into
"Bullet"
need for more
approach
knowledge
Modell
E. First try
[Right Model]
D. Knowledge
based on
acquisition
"Cookbook"
approach
[Len Model}
[Ler Model]
Thinking
Figure 1. The 4MAT system model. From The 4MAT System: Teaching to Learning Styles with Right/Left Mode
Techniques by Bernice McCarthy. © 1980, 1987 by Excel, Inc. Used by special permission. Not to be further repro-
duced without the express written permission of Excel, Inc. Those desiring a copy of the complete work for further
reading may acquire it from the publisher. Excel, Inc., 200 West Station St., Barrington, IL 60010, (708) 382-7272.
radical mastectomy, or a partial mastectomy
received some training about the clinical fea-
(lumpectomy). All women are currently free
tures of breast cancer and specifics of BSE and
of disease and are being seen regularly by a
mammography.
physician. Two women had radiation therapy,
The witnessing presentations were based
and two were taking tamoxifen. All live on
upon the personal experience and story of each
fixed incomes and their socioeconomic status
woman. They were original and varied some-
ranges from below the poverty level to lower
what from program to program, depending
middle class. They had no public speaking ex-
upon the nature of the audience and the set-
perience, as this was their first experience with
ting. The witnessing program lasted from
a service organization.
20-40 minutes. Following the witnessing, par-
With guidance, these women planned pub-
ticipants asked questions and discussed con-
licity and methods of contact with the African-
cerns with the role models. Next, BSE was
American populations and churches, and they
taught by trained instructors who use ethnic
provided advice on overcoming specific cul-
models and simple written materials. Each
tural barriers. In the beginning, these women
participant had an opportunity to practice
were paid approximately $10 per session.
lump detection with various models. Plenty of
Later, they volunteered their time as witnesses
practice time was allowed with various Health
and role models for the program. The women
Edco and Mammacare breast models. Addi-
Role model intervention
315
tional literature regarding breast cancer and
RESULTS
cervical cancer was available.
The role model intervention program was
Because of the previously observed low
conducted during spring and fall 1991, at
participation rates among African-American
church and community sites in urban and ru-
women in breast cancer awareness programs,
ral areas. One program was held at the King
the first goal was to increase attendance. The
Solomon Baptist Church in a neighborhood
witness program was pilot-tested in three com-
where 67.2% were African American and
munities in Arkansas, using the congrega-
57.8% were below the poverty level. The sec-
tions of area churches. A total of 78 women
ond site was a church in a small rural commu-
participated.
nity of 21,147, people of whom only 34.9%
Table 1 presents a breakdown of the socio-
were African Americans and below the pov-
demographic characteristics of the participants
erty level. The third site was a Mississippi River
by community. Most of the women who at-
Delta community in east Arkansas of 7,361
tended the witness program were African-
people of whom 63.9% were African Ameri-
American, but several caucasians also attended
can and 65.8% of the population was below
the program. About two-thirds of the women
the poverty level.
participants were 35 years of age or older, the
Program participants first were asked to
age at which screening mammograms were ini-
complete a questionnaire that asked for demo-
tially recommended. Most of the participants
graphic information, health attitudes and be-
were married. Several sets of mothers and
liefs, and current BSE and mammography
daughters attended the program together. Al-
practices. Three months after the witnessing
though almost half of the participants had a
presentation, a follow-up questionnaire was
high school education, only 42% had a fam-
mailed to all participants with a self-addressed,
ily income of over $15,000 per year. Almost
stamped envelope for return mail. After three
a quarter of the participants were not covered
weeks, a direct telephone interview was used
by health insurance.
until an 80% response rate was reached. These
Of the initial 78 participants in the witness-
interviews were conducted by one of the Afri-
ing program, 63 women (82% of the sample)
can-American role models.
responded to the follow-up questionnaire at
Table 1. Sociodemographic characteristics of participants by site
Helena
King Solomon
Russellville
(N = 50)
(N = 18)
(N = 10)
n
n
n
(%)
(%)
(%)
Chi-square
Age 35 years or older
32
13
6
n.s.
(64.0)
(76.5)
(60.0)
African-American
39
18
10
n.s.
(88.6)
(100.0)
(100.0)
Married
16
11
6
6.62*, 2 d.f.
(36.4)
(64.7)
(75.0)
Family income >$15,000
12
7
6
n.s.
(31.6)
(50.0)
(75.0)
Education > High School
21
5
5
n.s.
(51.2)
(31.3)
(62.5)
Health insurance coverage
30
11
7
n.s.
(69.8)
(91.7)
(87.5)
*p < .05; n.s., not significant. Percentages are based on valid responses to individual questions and may reflect missing
values.
316
D.O. ERWIN et al
three months. A portion of the nonrespon-
without confidence to performing BSE some-
dence was due to inadequate name, address,
what confidently.
and telephone information. Comparison of
Among the 63 respondents to the follow-up
the respondents to the follow-up survey with
questionnaire, 12 women reported that they
the nonrespondents found no differences be-
obtained a mammogram following the witness
tween the groups in the characteristics of race,
program. The women who obtained mammo-
age, education, income, or health insurance
grams ranged in age from under 35 years to
coverage. In the follow-up survey respondents
over 65 years. Two women under age 35 re-
and nonrespondents did not differ in their
ported having mammograms; both of these
baseline reports of perceived risk of breast can-
women had reported risk factors for breast
cer, history of mammograms, frequency of
cancer (eg, family history of breast cancer, his-
practice of BSE, or confidence in the practice
tory of benign breast lumps). Four of the 12
of BSE.
women who reported mammograms reported
To evaluate the effectiveness of the witness
that they had never had a mammogram be-
program to increase the practice of BSE and
fore. Two of these four women were the young
screening mammography among African-
women under 35 years of age.
American women, a comparison was made
of responses given at baseline with those at
DISCUSSION
follow-up. Table 2 presents the change from
baseline to follow-up in the reported frequency
Several caveats must be considered prior to
and confidence of BSE. A significant increase
discussion of the findings. First, the sample
in both frequency and confidence in practice
lacked a control group. Therefore, we cannot
of BSE was noted. Between baseline and fol-
ascertain the extent to which the changes ob-
low-up, there was a large decrease in the num-
served from baseline to follow-up may be at-
ber of respondents who reported that they did
tributed to the witnessing program. Second,
not practice BSE at all and a large increase in
the data presented were based on self-report.
the number of women who reported practic-
There may be some bias in responses towards
ing BSE more than monthly. In terms of re-
more socially acceptable answers.
ported confidence in practice of BSE, the
The data reported were a result of a prelim-
women appeared to change slowly from not
inary investigation of the feasibility of an Af-
performing BSE at all to performing BSE
rican-American role model intervention to
Table 2. Breast self-examination (BSE) at baseline and follow-up
Baseline (%)
Follow-up (%)
Chi-square
BSE frequency
Do not perform BSE
18 (30.0)
2 (3.2)
-
1 or 2 times per year
9 (15.0)
8 (12.9)
1
3 or 4 times per year
3 (5.0)
6 (9.7)
-
5 to 8 times per year
2 (3.3)
2 (3.2)
I
Monthly
22 (36.7)
11 (17.7)
I
More than monthly
6 (10.0)
33 (53.2)
36.19***, 5 d.f.
BSE confidence
Do not perform BSE
13 (22.4)
2 (3.3)
Not confident
15 (25.9)
19 (31.1)
Somewhat confident
18 (31.0)
28 (45.9)
Confident
9 (15.5)
9 (14.8)
Very confident
3 (5.2)
3 (4.9)
10.64*, 4 d.f.
*p < .05; ***p < .001.
Role model intervention
317
increase BSE and mammography. The results
In trying to counteract fatalism, negativism,
of this initial intervention program suggest that
and low knowledge levels within the African-
the use of role models, witnessing design, and
American community with regard to cancer,
the use of the 4MAT® method is effective in
the witnessing process and role models pro-
recruiting participants and holds potential for
vided positive experiences in contrast to the
motivating African-American women to learn
many negative experiences these people may
BSE and to have screening mammograms. The
have had in the past with cancer in their fam-
authors continue to develop the program and
ily and friends. A feature of the role model
plan to launch a full-scale evaluation of the
program that traditionally has not been found
program using control communities and mul-
in health education programs is the advocacy
tiple measures of assessment.
and empowerment that is encouraged from
The advisory group lent their credibility and
the participants by the role models. This may
provided the bridge to allow the authors to es-
be a key issue in the initial behavioral change
tablish credibility of their own with the target
process.
population. The target population (ie, those
Designing an innovative health education
women from the African-American popula-
program for special populations is a time- and
tion who are not routinely practicing BSE and
labor-intensive process, which requires process
mammography and who are from relatively
evaluation as well as some end-results evalua-
low-income and low educational level popu-
tion. The program is not cheap. At least 345
lations) responded.
man-hours had been spent by the time the first
The task of educating women who are not
program was completed. This included time
from the typical health conscious population
spent by paid staff, volunteers, American Can-
to participate in health screening activities, ap-
cer Society staff, and the patient role models.
pears to be addressed with the 4MAT® method.
Follow-up of survey data has proved to be
The authors suggest that this target audience
difficult. People move frequently even within
requires a culturally sensitive, more right
the small rural towns, and many participants
brain-oriented focus than the standard ap-
are without telephones. The necessity to ac-
proach commonly used in health education.
commodate for low reading levels and lack of
One of the most effective means of direct-
successful test-taking experience (ie, complet-
ing the information to the target audience is
ing questionnaires) presented particular re-
through the local churches. The individuals
straints. The low education and reading level
within the churches take a personal interest in
of the participants often preclude completing
the program and thereby increase participation
health surveys and questionnaires for research
levels by personally inviting members of the
purposes without help from staff or other vol-
congregation, friends, neighbors, and rela-
unteers. Likewise, reliability of data from
tives. This, in turn, reaches more of the pop-
these health survey questionnaires can be
ulation who would not necessarily attend a
somewhat questionable as the population is
health education program, but would attend
not comfortable or trained to complete this
a social event sponsored through the church
type of pen-and-paper survey. Evaluation of
by a close friend or acquaintance.
the pre- and posttest surveys determined that
Once individuals arrived at the location, the
individual interview methods are more effec-
effectiveness of the role model program was
tive and accurate for obtaining truthful data
evident through participant responsiveness. As
from the target population than the pen-and-
an educational program, the witnessing and
paper, mail-in methods originally designed.
role model intervention provided a natural
The role model intervention, including the
and comfortable method for reaching less-
training program for BSE and discussion of
educated, lower income African-American
mammography itself, did not require any writ-
women. Also, it is well suited for application
ing or reading, and everything was done with
for other health issues.
low-reading-level brochures available. All of
318
D. O. ERWIN et al
the educational process included spoken, face-
4. Richardson J, Marks G, Solis JM. et al: Frequency
to-face directives. However, the evaluation did
and adequacy of breast cancer screening among el-
require some kind of written or oral survey.
derly Hispanic women. Prev Med 16:761-774, 1987.
5. Bloom JR, Hayes WA, Saunders F, Flatt S: Cancer
There is a need to develop a more sensitive as-
awareness and early cancer detection practices of
sessment of BSE knowledge and practice for
Black Americans. Fam Community Health 10:19-
this population. Women reported BSE prac-
30, 1987.
tice, but indications were that the participants
6. Henschke UK, Lefall LD Jr, Mason CH, al: Alarm-
were inadequate in their BSE proficiency. The
ing increase of the cancer mortality in the US black
authors are concerned that women are under
population (1950-1967). Cancer 31:763-768, 1973.
7. Freeman HP: Cancer in the socioeconomically disad-
the false assumption that they are performing
vantaged. CA 39:266-288, 1989.
BSE correctly, and, therefore, believe they
8. Cancer Facts and Figures for Minority Americans
would detect symptoms of breast cancer.
1991. Atlanta, Georgia: American Cancer Society,
Although these results are preliminary
1991.
9. Otten MW Jr, Teutsch SM, Williamson DF, Marks
and evaluation is continuing, the role model
JS: The effect of known risk factors on the excess mor-
intervention demonstrates potential as a suc-
tality of black adults in the United States. JAMA
cessful method to reach a portion of the Afri-
263:845-850, 1990.
can-American community of women who have
10. Boring CC, Squires TS, Health CW: Cancer statis-
not been reached through traditional methods.
tics for African-Americans. CA 42:7-17, 1992.
11. Baquet CR, Horm JW, Gibbs T. Greenwald P: So-
As was stated earlier, this is a starting point for
cioeconomic factors and cancer incidence among
changing the behavior of African-American
blacks and whites. J Nail Cancer Inst 83:551-557,
women with regard to BSE and mammograms.
1991.
The first step is awareness and prioritization
12. Short P, Monheit A, Beauregard K: A profile of un-
within the community of African-American
insured Americans. National Medical Expenditure
women to address the issues and risk of breast
Survey Research Findings 1, National Center for
Health Services Research and Health Care Technol-
cancer. The program in Arkansas is now de-
ogy Assessment. DHHS Publication No. (PHS) 89-
veloping a critical mass of individuals who
3443. Washington, DC: Department of Health and
have experienced the program. This, in turn,
Human Services, September 1989.
is part of a statewide process in providing en-
13. Burack RC, Liang J: The acceptance and completion
try and access for more African-American
of mammography by older black women. Am J Pub-
lic Health 79:721-726, 1989.
women. In addition, it is recognized that one-
14. Denniston R: Cancer knowledge, attitudes and prac-
time exposure to a cancer education program
tices among black Americans. In, Mettlin C, Murphy
is not enough to effectively change behavior.
GP (eds): Cancer among black populations. New
Therefore, the continuing interest and expo-
York: Alan R. Liss, 1981, PP 225-235.
15. Michielutte R, Diseker R: Racial differences in knowl-
sure within the community will be one of the
edge of cancer. Soc Sci Med 16:245-252, 1982.
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16. Saunders LD: Differences in the timeliness of diag-
and subjective norms and therefore providing
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positive patterns for cancer screening, not only
79:69-70, 1989.
for breast cancer but in other types of cancer
17. Freeman HP, Wasfie TJ: Cancer of the breast in poor
and disease.
black women. Cancer 63:2562-2569, 1989.
18. Cancer and the poor: A report to the nation. Find-
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FIRST LADY HILLARY RODHAM CLINTON
MAMMOGRAM ROUNDTABLE
KIMBALL SENIOR CENTER
NATIONAL CITY, FLORIDA
JANUARY 26, 1995
TALKING POINTS
INTRODUCTION
Nearly every family in America is touched at one time or another by
breast cancer. We all know someone -- a grandmother, mother, sister, aunt,
daughter, niece or, in my case, a mother-in-law -- who has suffered or is
suffering from the disease.
The numbers are shocking: about 1 in 8 women in this country will
contract breast cancer during her lifetime. The rates are getting higher every
year. And older women are the most vulnerable because the chances of getting
breast cancer increase with age.
While these numbers are distressing, it is equally distressing that many
older women who are eligible for breast cancer screenings don't take advantage
of them.
Medicare covers regular screenings for women over 65 and diagnostic
screenings whenever a doctor thinks it is medically appropriate. Yet nearly two-
thirds of women eligible under Medicare don't get mammograms. Many women
don't get mammograms because they think they are safe until a problem arises.
In other cases, women don't get screened because their doctors never
recommend it. Some women are afraid of mammograms, or embarrassed at the
idea of having a breast screening. In fact, mammograms are safe and those
administering them are trained professionals.
*
Over the past 2 years, many older women have conveyed their concerns
about breast cancer to me. Their anxieties and problems in dealing with the
disease prompted me to learn more about programs that might help. Through
officials at the Department of Health and Human Services, I learned that too
few older women were taking advantage of the Medicare mammography
benefit. I hope that my visit to Beth Israel today will help raise awareness about
this issue.
THE MEDICARE BENEFIT FOR BREAST SCREENINGS IS AN
EXAMPLE OF GOVERNMENT WORKING FOR YOU
*
The whole point of government is to make it work for people. Medicare
coverage for breast screenings is one of a number of ways the federal
government is involved in the fight against breast cancer. Along with research
at NIH and other agencies, this program offers a direct benefit to a segment of
the population at high risk for a deadly disease.
WE HAVE A PROGRAM IN PLACE THAT CAN SAVE LIVES
We have a program in place. We have a program that can save lives.
Now we have to make sure that patients, doctors, and all health care providers
are aware of the importance of regular mammograms, particularly for older
women.
THIS PROGRAM IS AN EXAMPLE OF HOW PREVENTIVE CARE
WORKS
Over the last two years, we talked a lot about preventive care as part of
health care reform. This is a perfect example of how a small investment today
can pay off down the road. A mammogram is much less costly -- in dollars and
emotions -- than surgery or serious illness. By taking advantage of this
Medicare benefit, thousands of older women cannot only be given the hope of
life, they can be given a higher quality of life. It's a win-win-win situation --
for patients, providers, and for all of us collectively who prosper from living in
a healthier society.
###
MAR-31-1995 12:00 FROM OASPA NEWS DIV
TO
91562878 P.02
DEAR PMI MEMBER AND OR POTENTIAL CORPORATE SPONSOR:
THE WHITE HOUSE IS PLEASED TO ANNOUNCE THE NATIONWIDE LAUNCH OF
A CAMPAIGN FOCUSING ON OLDER WOMEN'S HEALTH. THE "MAMA-GRAM"
CAMPAIGN FORMALLY KICKS OFF MAY FIRST AT THE WHITE HOUSE
TO
COINCIDE WITH MOTHER'S DAY MAY FOURTEENTH. THE ATM TS TO INCREASE
AWARENESS IN WOMEN OVER 65 ABOUT THE NEED FOR MAMMOGRAMS
A
BENEFIT COVERED BY MEDICARE. BREAST CANCER AFFECTS ONE IN EIGHT
AMERICAN WOMEN AND SIXTY PERCENT ARE OVER G5 YEARS OLD.
DURING THE PAST SEVERAL MONTHS I HAVE CRISSCROSSED THE COUNTRY
LISTENING TO OLDER WOMEN SHARE THEIR STORIES AND FEARS ABOUT
MAMMOGRAMS AND BREAST CANCER. I HAVE LEARNED THAT WITH THE RIGHT
INFORMATION AND OUTREACH, WOMEN OVER 65 WANT TO DO WHAT THEY CAN TO
LIVE LONGER AND HEALTHIER LIVES.
THE MAMMOGRAPHY CAMPAIGN WILL RUN FROM MOTHER'S DAY TO MOTHER'S
DAY OF 1996. DURING THE YEAR THERE WILL BE SPECIAL EVENTS, PUBLIC
SERVICE ANNOUNCEMENTS AND VARIOUS MATERIALS PLANNED TO EXPAND THE
AWARENESS.
I INVITE YOU TO JOIN US IN THIS IMPORTANT OUTREACH
CAMPAIGN. (LINE HERE NAMING CREATIVE TEAMS FOR THEIR SPECIFIC
LETTERS.) YOU CAN HELP PROVIDE VITAL INFORMATION TO THOSE WIIO NEED
THIS LIFE SAVING MESSAGE.
SINCERELY YOURS,
HILLARY RODHAM CLINTON
SERVICES
U.S. Department of Health and Human Services
UNIVERSITY
JACKIE NEDELL
Communications Director
Room - 634-E
Hubert H. Humphrey Building
200 Independence Ave. S.W.
(202) 690-5897
Washington, DC 20201
FAX (202) 690-7318
03/31/95
13:39
opha Our goal IS
campargn
002
the WHT remogness Dray, May
14/7
to
will
the Day
Dear FMI Member:
1996
1
On Mother' Day, May 18 1995, the Clinton Administration
will launch a nationwide "Mamagram" campaigns to increase
awareness about the life-saving potential of mammograms for women
over the age of 65 and about Medicare coverage for mammograms.
of
Screening mammograms can detect breast cancer early -- in time
for successful treatment and cure -- yet only 37 percent of women
over 65 take advantage of the mammography benefit offered by
Medicare.
several
During the past / months [of course, depends on when
letter goes out first event was Jan 17], I have travelled experiences
around the country listening to older women share their storice, feelings
their feelings (?) Minsights2] and their fears about mammography
and breast cancer. I have learned that, with information and
outreach, women over 65 will get mammograms to help them live
longer, healthier lives.
I hope you will join us in this outreach campaign.
Throughout the coming year, the Health Care Financing
Administration, which runs the Medicare program, will work with
local agencies on aging, state health departments, and private
organizations to spread the word about Medicare and mammography
to older women and their health care providers. By using the
enclosed materials on advertisements, flyers, grocery bags and
in-store promotions, you can provide vital information and help
send this life-saving message to your customers.
special
Sincerely yours,
public service
Hillary Rodham Clinton
until
From this mothers day to
03/31/95
13:39
003
Dear Friends:
On Mother's Day, May 14, 1995, the Clinton Administration
will launch a nationwide "Mamagram" campaign to increase
awareness about the life-saving potential of mammograms for women
over the age of 65 and about Medicare coverage for mammograms.
As you know, screening mammograms can detect breast cancer early
-- in time for successful treatment and cure -- yet only 37
percent of women over 65 take advantage of the mammography
benefit offered by Medicare.
During the past two and a half months I have travelled
around the country listening to older women share their stories,
their feelings (?) [insights?] and their fears about mammography
and breast cancer. I have learned that, with information and
outreach, women over 65 will get mammograms to help them live
longer, healthier lives.
I want to thank you all for your participation in our
efforts to date, and I look forward to continuing our productive
partnership throughout the Administration's outreach campaign.
Throughout the coming year, the Health Care Financing
Administration, which runs the Medicare program, will work with
local agencies on aging, state health departments, and private
organizations to spread the word about Medicare and mammography
to older women and their health care providers. Together, we can
succeed in increasing the usage of this powerful weapon in the
fight against breast cancer among our nation's older women.
Sincerely yours,
use
Hillary Rodham Clinton
Mamm
May 4 - 8:30 9:30 a.m.
Call
Name - by end of next week - Susan B.
Mobite unit
Get event mineo
/ or 2 people to invite
to Jeicry
Display FDA certification
Do it after her specch
First Lady's Comments
Invitation / Announcement
May I - a.m. - East Room
First Lady's puch
Fact sheet - HCFA to do
Quote for program
Letter to Food Marketing Institute
Same letter !
Letter from First Lady talking about campaign - -
HCCA to fax to me
For
Senior newsletter -early next week
Call
Jeremy
?
Letter from President on WH Conf on Aging
stick something in about 1st Lady's session
»»p
EXECUTIVE OFFICE OF THE PRESIDENT
30-Mar-1995 11:32am
TO:
Marilyn Yager
TO:
Barbara D. Woolley
FROM:
Karen R. Guss
Office of the First Lady
CC:
Jennifer L. Klein
SUBJECT:
HRC kickoff program quote
I added those key words we all know and love to the suggested
mammography quote and ran it by Jen. How does this strike you:
" [Medicare coverage of mammography] is about saving lives and
enhancing the quality of life for older women. We have a program
in place. We have a program that works. Now we have to make sure
that older women and their doctors and all health care providers
know about it. "
- - HRC quoted by Tom Oliphant in the Boston Globe