March 2012
Feature Story

Gail Zyla

It’s 8:15 on a rainy Saturday morning, and dozens of women are lined up outside a Houston building waiting for the doors to open at 9 AM. No, it’s not concert tickets, the latest iGadget, or sale merchandise they’re after. It’s the opportunity to have a Pap test and get the results, along with a followup care plan if needed—all in one day and all at no cost.

The Jan. 21 event was the latest of the CAP Foundation’s See, Test, and Treat programs. Launched in 2001, the program was created to provide free cervical and breast cancer screening to women in medically underserved communities. Pathologists work with gynecologists, radiologists, and other clinicians to perform the screening tests and provide the results, regardless of the woman’s ability to pay.

Dina R. Mody, MD, medical director of cytopathology at Houston’s Methodist Hospital, spearheaded the Jan. 21 event. “We have a huge population of underserved Latina women in Houston, and charity begins at home,” she says.

To reach them, Dr. Mody partnered with “Dia de la Mujer Latina” (Day of the Latina Woman), a communitywide health fair that provides outreach to Houston’s Latino community. Latino clubs, private and nonprofit organizations, state and county health departments, local merchants, media, volunteers, and health care providers work together to offer screening for not only breast and cervical cancer but also diabetes and cardiovascular disease. The CAP Foundation supported the program with a grant of $8,000. Pathologists and cytotechnologists from Methodist Hospital volunteered their services, as did gynecologists and gynecologic oncologists from Methodist, Baylor, and MD Anderson. Hologic, of Marlborough, Mass., donated through the foundation $6,000 in supplies and equipment.

“We aimed to do 100 Pap tests that day in See, Test, and Treat,” Dr. Mody says. “We wound up testing 187 women at the fair, and we literally had to shut the doors at 2 PM, when the event ended, and turn 87 people away.”

Of the 108 tested through See, Test, and Treat, eight women had abnormal Pap results. Five same-day colposcopies were performed. “We’d rather screen them and treat them up front,” Dr. Mody says.

The CAP and its foundation want to expand the See, Test, and Treat program to the urban, suburban, and rural communities where the need for preventive care is most critical. Plans are underway for two more programs in Texas and to expand the existing programs in Boston and Minneapolis. “I wouldn’t be surprised to see a number of new programs launched in 2012,” says Jennifer L. Hunt, MD, MEd, president of the CAP Foundation and chair of pathology and laboratory medicine, University of Arkansas for Medical Sciences, Little Rock.

The foundation provides grants of as much as $25,000 to cover program expenses that other grants and in-kind donations do not cover. Foundation funds pay for medical supplies and equipment rental and transport, laboratory support in clinic settings, promotional materials, educational aids, translators, on-site child care, patient transportation, and meals. Federal, state, local, and private grant programs provide financial assistance to institutions that offer health services to uninsured and underinsured women.

“It’s an exciting time for the program because we have the support of the foundation to move it to a broader audience in the United States,” says Gene N. Herbek, MD, CAP president-elect. Dr. Herbek launched the first See, Test, and Treat program for Native American women living on federal lands in South Dakota, who are at higher than average risk for cervical cancer and suffer higher death rates from the disease. That pilot served as a model for the programs in Boston, Houston, and Minneapolis, the latter of which was endorsed recently by the Centers for Disease Control and Prevention.

“See, Test, and Treat programs provide an opportunity for pathologists to do direct patient care and work side by side with other clinicians,” Dr. Herbek says. “They underscore the pathologists’ connection to patients.”

“Lots of underserved women are too busy to take time away from work, children, and other commitments to come in for screening,” says Bradley M. Linzie, MD, medical director of surgical pathology, Hennepin County Medical Center, Minneapolis. Dr. Linzie has provided free pathology services since 2007 to underserved African American, Hispanic, Somali, and Hmong women via the See, Test, and Treat program at Minneapolis’ NorthPoint Health and Wellness Center.

“We’re lucky to get these women in once for screening, so we push the limits of what we can do in one visit,” says Dr. Linzie. “I bring in teaching slides to show patients, and I sit down with them and explain what we see.” For many women, this is their first time in the health care system, and the one-on-one interaction makes it possible to answer questions and helps to allay fears. “Talking with the patients helps take a lot of the mystery away,” he says.

But the educational effort is much broader than that. “In the Hmong community, for example, we found that educating women and the entire family is key to understanding and demystifying the process,” says Donn J. Vargas, NorthPoint’s community outreach coordinator. Before the screening day, NorthPoint hosts a traditional Hmong tea during which many from the community are educated about the health screening process and participants can meet staff from and tour the clinic.

Addressing cultural and language barriers is the most pressing up-front need, says Barbarajean Magnani, PhD, MD, chair and pathologist-in-chief, Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston. Dr. Magnani organized Boston’s first See, Test, and Treat program in the city’s Chinatown neighborhood after seeing a video about the NorthPoint program. “I was so moved by the video,” she says. “We have so many underserved women and patients from Chinatown [site of Tufts Medical Center] that I thought, wouldn’t it be great to give back to the community and do something similar.”

Many of the Chinese women made it clear to Dr. Magnani and others organizing the program that they don’t see doctors unless they have a problem. To encourage women to come in for screening, Dr. Magnani says, the program had to recognize and address their culture of “Nothing is wrong. Why should I go?”

“We’ve screened about 40 women each year,” she says of Tufts’ two See, Test, and Treats. “At the end of the day you feel exhausted but so good about what you’re doing.” And it’s been “a great way for us to bring [Tufts] departments together.”

Forty-three women were seen at the Oct. 15, 2011 program at Tufts, 32 of whom had Pap tests. Ten (31 percent) had abnormal results—eight were ASC-US (atypical squamous cells-undetermined significance) and two were low-grade dysplasias. Twenty-four HPV tests were performed, of which three were positive. Followup included five same-day colposcopies.

Twenty-one mammograms were performed; two were abnormal. Nineteen patients were tested for chlamydia/gonococcus; no positives were found.

In Minneapolis, also in October, of the 156 patients served, 71 had Pap tests, of which four percent were abnormal—one ASC-US, two high-grade dysplasias. Of the two confirmed high-grade dysplasias, one patient was diagnosed with invasive cervical cancer upon examination of the biopsy and the other was diagnosed with CIN3.