Agency Teaches Latinas in Fight Against Cancer

Olivia Salcido holds up a gel-filled model of a breast to explain what a tumor feels like and suddenly the women look concerned.

They imagine finding lumps, or bultos, hidden under their skin, leading to painful and prolonged treatments and piles of medical bills.

The women of this largely Spanish-speaking blue-collar neighborhood know cancer as a death sentence. And many prefer not knowing any more than that.

But a local group is seeking to overcome such fears, as well as cultural barriers, through a program that teaches women how to check for early signs of the disease.

“I know that in our culture they say we shouldn’t do this, that we shouldn’t look at ourselves,” Salcido tells a group of women. “But only we know what is right for us and what is not right.”

The health educator is showing diagrams of how to perform a breast self-exam in front of a mirror during a recent Sunday morning health fair at Santa Rosa Catholic Church. Volunteers also pass out bilingual pamphlets on local social service agencies, immunizations and AIDS.

Salcido’s presentation is sponsored by the Mission City Community Network Inc., a nonprofit agency that provides free breast and cervical examinations to low-income women.

Inside Room 4, a dozen women, some of whom have just come from Mass, listen as Salcido talks about the importance of monthly breast self-exams. She explains how biopsies are performed and how pain in a breast does not necessarily mean cancer. Pink and blue sheets hang on a clothesline set up to create makeshift “examining rooms” inside the church school classroom.

To fulfill her mission of teaching about early cancer detection, Salcido says she must first clear up misconceptions about breast and cervical examinations.

Many women who could be examined for free at county hospitals avoid them because of cultural and religious beliefs, language barriers and fears of being deported, she says.

In some cultures, says Salcido, speaking about an illness is like inviting a bad omen.

“It’s very difficult to change their minds,” she says. “A lot of women think they don’t have to have a Pap test. They think that when they had children, then they already had an exam. Older women don’t think they have to have the exam because they no longer have a sexual partner, and you have women who are in their 30s who are virgins that have never had a Pap.”

Among some older Latinas, rumors about mammograms often discourage visits to physicians, says Salcido.

“Women were saying that they are not getting mammograms because it would increase their chances of cancer because of the radiation,” she says. Other rumors include the notion that those who do not engage in sexual activity will not get cervical cancer.

“I tell them that cancer does not discriminate,” she says. “Cancer does not choose between the woman that has sexual intercourse and the woman that hasn’t. I tell them that even nuns get cancer.”

Other women avoid exams because of difficulties finding child care or transportation to county facilities, said David Delgado, a USC epidemiologist who helped create the North Hills-based Mission City organization four years ago. He has researched the link among Latinas, breast cancer and income.

“What I hate is that the survival of a woman is linked to her income,” said Delgado. “The whole notion of poverty and cancer really makes me angry. Health care is not really a right, but a privilege.”

That is the impetus behind Mission City. Funded by the national Centers for Disease Control and Prevention and the state Department of Health Services, the clinic’s staff of nine provides examinations, diagnoses and, if needed, referrals for surgery and treatment.

The clinic also provides weekend examinations around the San Fernando Valley at churches, temples, senior centers and the YWCA.

“Basically, [the clinic] goes to those places [women] go, where they feel in control,” said Delgado. “The whole issue is having a quality program that is like a clinic in a safe zone. The place of worship is a place of safety for a lot of women.”

Women attending the sessions see videos and examine a life-size model of a torso that has one breast with a lump the size of a corn kernel. Mammograms are provided at a high-tech mobile lab.

Since it opened in 1992, the Mission City Community Network has served over 40,000 women, said Prudencia Kintaudi, medical director of the clinic. Last year, 15 breast cancer cases were diagnosed among 1,800 women who showed abnormalities. In clinical findings, women from minority groups tend to have higher rates of breast cancer at a younger age than the rest of the population, said Kintaudi.

But the combination of early-detection programs and better treatment has contributed to a decrease in deaths among women with breast cancer, said Dr. Patricia Ganz, director of the division of cancer prevention and control research at the Jonsson Comprehensive Center at UCLA.

“People who have access to state-of-the-art care have a better chance of survival,” Ganz said.

Once the disease is diagnosed, low-income women face other obstacles, said Dr. Lucille Leong, oncologist and medical director for the City of Hope’s Mobile Program in Duarte, which is similar to Mission City’s.

“One of the big stumbling blocks is, when do these women get treated,” she said. “Getting people through the system for treatment is always difficult.”

Part of the problem was solved three years ago with the creation of the Breast Cancer Early Detection Regional Partnership, a program that receives funds from the state’s 2% cigarette tax. With supplemental funding from Blue Cross, the program works in cooperation with clinics, which assures that a woman who qualifies will receive proper treatment within 60 days of diagnosis. The program pays for all medical expenses if the woman cannot afford them.

The goal of the program is to guarantee medical services to low-income women and to provide a successful network between clinics and county hospitals to ensure that a woman who is “200% low-income and uninsured gets treatment,” says Jade Singer, clinical service coordinator for the partnership.

Kintaudi says through the partnership program and a referral system with UCLA-Olive View Medical Center in Sylmar established by Delgado, Mission City can assure that a woman who qualifies will receive treatment, from operations to chemotherapy and post-examinations.