It had been seven years since Maria Martinez’ last mammogram, and she’d never been to the doctor for a pap smear.
At night, she couldn’t sleep. The pain in her breast was too severe and worry weighed on her.
One thing stood between Maria and regular screenings for breast and cervical cancer: Insurance.
“For those of us uninsured, we are our own doctors,” Maria said. “We prescribe our own medication if we have fevers or need something like an antibiotic. We go out and get it where we can.”
The choices are tough and the options few.
“Many of us preferred to pay for our children’s education than to pay for health insurance or medical services,’ she said.
Maria is one of 50 women who participated in Illinois’ first See, Test & Treat program, an initiative of the College of American Pathologists Foundation that delivers free, pathologist-led cervical and breast cancer screening to underserved women throughout the country.
Eva Wojcik, MD, FCAP, lead pathologist at Loyola University Medical Center, recognized a unique need in her own hospital’s backyard. Many Polish, African-American, Hispanic, and Caucasian women don’t have access to health services.
“I started with Wendy, our president, and other administrators,” Dr. Wojcik said. “I told them about the program and how important it is. They listened. They decided this was important and was exactly what Loyola’s mission is. We serve the community. Once the senior administrators decided they wanted to do it, we started to work.”
Loyola’s president didn’t need much convincing. As part of the hospital’s community benefit plan, they find ways to serve the Maywood community. Providing vital health services was a natural fit.
“I hope these women have a great experience, that none of them has a bad finding,” Wendy Leutgens said. She greeted many of the women at the door before their screenings. “But if they do, I hope we catch it early; and they get connected to the care they need. Maybe some of them will connect with a doctor and realize how important preventative care is.”
Diseases like cervical cancer can be prevented through early detection. At See, Test & Treat, patients receive same-day screening results and immediate access to follow-up care. Pathologists lead a collaborative, multidisciplinary team of volunteers to ensure that women facing health disparities and socioeconomic barriers get the life-saving care they need.
When Dr. Wojcik sees cancer on the glass slide of a Pap test, she views it as a failure, a failure of the health care system. She believes no woman in the twenty-first century should have cervical cancer, and she focuses on detecting the changes that occasionally can lead to cancer.
“We sometimes forget there are human beings behind each and every specimen,” Dr. Wojcik said. “Behind each and every glass slide is somebody’s mother, somebody’s father. These are people, and we’re here because of our patients.”
Maria’s screening mammogram showed an abnormality in her breast. Every day, she’d thought about going to the doctor. Choking back tears, she said she’s grateful she decided to take advantage of See, Test & Treat.
“They are going to follow me,” Maria said. “If I had not known about this program, I would have developed cancer and never been able to do anything about it.”
Living in the gap
Many of the women who came to Loyola for screenings lack health insurance. But they’re not all unemployed and living below the poverty line.
Marta Polanco is a part-time real estate agent and secretary in her daughter’s medical practice. She makes enough to pay her mortgage and her income taxes—but that’s all. There’s nothing left over.
“It’s either my health insurance or a roof over my head to live,” Marta said.
She can’t afford adequate health care, but she earns too much to qualify for Medicaid. She’s a woman caught between the cracks or “going down the drain” as she put it.
Her daughter offered to send her for a mammogram when she complained of discomfort in her left breast, but Marta hesitated—for years.
“I kept postponing,” she said. “I thought I’d do it later, some other time. I’ve been afraid to find out.”
Paula Kezdi-Rogus, a radiologist at Loyola who specializes in breast imaging, she read the screening mammograms for the women at See, Test & Treat.
She looks for masses that are new, areas of asymmetry or density. Also, it’s her job to find abnormal clusters of calcification in the ducts of the breast that can be early signs of malignancy.
The stories of women who wait and delay screenings are very familiar to her.
“We try to reduce anxiety as much as we can,” Dr. Kezdi-Rogus. “It’s a scary thought that you may have an abnormality. But if we can tell a woman as fast as possible that everything is benign, that makes it as easy and anxiety free as possible.”
The news for Marta was good. Her results came back all-clear for any signs of breast cancer.
A family affair
They smile at each other and sometimes hold hands, finishing each other’s sentences.
They’re mother and daughter.
Irma Gutierrez lives with her daughter, Laura and her 11-year-old grandson, Alan. She cooks Spanish meals for the family, and Laura can’t imagine life without her.
“My mom is everything, so I need to take care of her,” Laura said.
And she did on a cold, rainy Saturday when she took her mother to Loyola.
“She doesn’t drive, and we don’t have insurance,” she said. “We saw this was close to where we live, so we didn’t think twice. We just came.”
Over the years, they’ve neglected their health with infrequent visits to the doctor.
“As a child, I went to the doctor when I got sick,” Laura said. “When I was little, I was in Mexico, and it was hard to go to the doctors for checkups.”
Laura works in an Avon factory as a machine operator and has insurance through the company. But her mother isn’t covered.
These are the kinds of stories that motivated Susan DiSalvo, residency program coordinator for pathology at Loyola, to volunteer her time.
“Sometimes when you catch things, it’s too late,” DiSalvo said. “I know some women are afraid to do this kind of stuff. They worry people will know they don’t have insurance. But you can’t risk your health. It’s too important.”
Laura doesn’t work on Saturdays; so when she saw the ad for See, Test & Treat, she knew she had to bring her mother.
“It was important to check to see if she had some kind of cancer because you just never know,” she said.
Irma received favorable results. She and her daughter smiled when they left Loyola, relieved that she’s healthy.
Through 2014, the CAP and the CAP Foundation have sponsored 30 See, Test & Treat programs, helping more than 3,000 women in underserved communities throughout the United States.
The health of these women starts with the diagnosis, and the screening is the first step in disease prevention.
“I’ve been in a situation where I’ve needed help,” DiSalvo said. “For me, it feels good in my heart to be able to help and give back to others.”