Breast Health and Breast Cancer Findings of the Target Communities

Qualitative Data Summary

Based on the qualitative data, the following counties, Macon-Bibb, Jones, Monroe and
Peach, are likely to miss the HP2020 late-stage incidence target unless the late-stage incidence
rate falls at a faster rate than currently estimated. Macon-Bibb County is considered to be of
highest priority based on the time to reach late-stage diagnosis and mortality targets for the
HP2020. However, none of the counties in our service area have a significantly different
incidence rates, death rates, late-stage incidence rates, or screening proportions compared to
the US. Additionally, the late-stage incidence rate and trend in our service area is slightly higher
than the US. Late-stage incidence rates within these counties are higher for blacks than whites
and the death rate is slightly lower than the US. Specifically, there are substantially larger black
populations compared to the service areas of Macon-Bibb and Peach counties. Also, the
counties of Crawford and Twiggs are substantially lower in education rates. Peach County has
the lowest screening rate and is also the only county to show a rising incidence rate.
Selection of Target Counties
Macon-Bibb County is a high priority county. It is the metropolitan center of the Central
Georgia service area, as well as provides more available services compared to other counties.
A high percentage of Macon-Bibb citizens (45.3%) live below the poverty level and require
access to reduced or no-cost breast services. Additionally, there is substantially higher
percentage of underserved black females that live in Macon-Bibb County. As a result, it will take
13 years or longer to achieve incidence rate and 7 years to achieve death rate.
Monroe County is considered third for counties with the lowest education level. 21.3%
receive less than a high school education. Considering that the majority of the county is rural
(80.2%) and is 100% medically underserved, it will take 13 years or longer to achieve late-stage
incident rate; therefore making Monroe County a high priority.
Like Monroe County, Peach County is rural and medically underserved. A high
percentage of the population lives below the poverty level (41.7%). Also, a low percentage of
women receive recommended screenings in the service area. Specifically, 66.8% received a
mammogram in the last 2 years. Among these women, there is substantially a high percentage
of black females (48.9%). As a result, it will take about 13 years or longer to achieve late-stage
rates.
Quantitative Data Summary
The Quantitative Data report measured the breast cancer impact in the Komen Central
Georgia service area. Data was collected from many credible sources. The result of the
collected data was used to identify the highest priority areas in the service areas.
The following counties are likely to miss the Healthy People 2020 late stage incidence
rate target unless the late-stage incidence rate falls at a faster rate than currently estimated:
Bibb, Jones, Monroe, and Peach. Based on the time needed to reach late-stage diagnosis and
mortality targets identified by HP2020, the highest priority counties are Jones, Peach and
Monroe. Macon-Bibb County is also identified as a high priority by HP2020 based on the time
needed to reach late-state diagnosis and mortality targets.

None of the counties in our service area have a significantly different incidence rates,
death rates, late-stage incidence rates, or screening proportions compared to the US. Overall
the breast cancer incidence rate in the Komen Central Georgia service area was slightly lower
than that observed in the US as a whole and the incidence trend was lower than the US as a
whole. The incidence rate and trend of the Affiliate service area were not significantly different
than that observed for the State of Georgia. For the service area as a whole, the incidence rate
was slightly lower among Blacks than Whites. Overall the breast cancer death rate in the
Komen Central Georgia service area was slightly lower than that observed in the US as a whole
and the death rate trend was not available for comparison with the US as a whole. The death
rate of the Affiliate service area was significantly lower than that observed for the State of
Georgia. For the Affiliate service area as a whole, the death rate was slightly higher in Blacks
than Whites. Overall the breast cancer late stage incidence rate in the Komen Central Georgia
Affiliate service area was slightly higher than that observed in the US as a whole and the late
stage incidence trend was higher than the US as a whole. For the Affiliate service area the late
stage incidence rate was higher among Blacks than Whites
Another important piece of information from the Quantitative Data that is important to
consider is that the Affiliate service area has a substantially larger Black female population.
Macon-Bibb and Peach counties have the highest Black female population in the service area.
Also important to note is that the Affiliates education level is slightly lower than that of the US as
a whole. Crawford and Twiggs counties have substantially lower education levels than the rest
of the service area. Peach County has the lowest screening rate, and it is the only county to
show a rising incidence rate. The screening rate within the Komen Central Georgia Affiliate
service area is significantly lower than that observed for the State of Georgia.
From this data, the Komen Central Georgia Affiliate selected the following counties as
Targets: Macon-Bibb, Monroe and Peach. Macon-Bibb County was chosen for several reasons.
First, it is the metropolitan center of the service area and there are many breast health and
breast cancer resources available. It was marked as a high priority based on the Healthy People
2020 guideline; it was take 13 years or more to achieve the target incidence rate and about 7
years to achieve the target death rate. In Macon-Bibb County there is a substantially higher
percent of black females and 45.3 percent are living below the poverty line. This means the
residents of Macon-Bibb require access to reduced or no-cost breast services. Monroe and
Peach are both rural counties that are 100.0 percent medically underserved. Both counties were
marked as highest priorities by Healthy People 2020 because it is predicted to take 13 years or
longer to achieve late stage diagnosis target rates. Peach County had the lowest screening rate
with 66.8 percent of women getting their recommended mammograms in the last two years.
Peach County also has a very large Black female population and a high percent of people living
below the poverty level.
Health Systems and Public Policy Analysis Summary
Overall, the Central Georgia Affiliate service area has facilities and organizations that
provide services across the entire continuum of care and each target county receives limited
federal funding through the BCCP program to offer qualified women free services. However, the
Health Systems Analysis reveals there are major gaps in access to care within the target
counties.

Monroe and Peach County each have one health department which offers clinical breast
exams and one hospital that offers screening and diagnostic mammograms and ultra-sounds.
These services are limited. There are no additional diagnostic services and absolutely no
treatment or survivorship services in these two counties. There are no nurse navigators at the
county hospitals. Patients must rely on their doctor to direct them to treatment. If someone is
diagnosed with breast cancer they are usually referred to either a hospital in Macon-Bibb
County or to the hospital in Houston County. Houston County is a reasonable drive from Peach
County, but Bibb County is not within reasonable driving distance from either of the counties.
The lack of local breast health services in Peach and Monroe Counties creates a major burden
to breast cancer patients or survivors who have been diagnosed with breast cancer and need
further medical attention or support services. Poor breast health outcomes, such as high
mortality and high incidences of late-stage diagnosis could be related to lack of access to care
within each county.
Macon-Bibb County has accessibility to and quality care available; there are services
across the entire continuum of care in Macon-Bibb. There is a community health center, a
volunteer clinic, and a health department providing screening services and referrals for
screening mammograms. There are two major hospitals offering breast health services across
the entire continuum of care. A recent strength of Macon-Bibb County is the opening of a new
cancer center in November 2014 at the major hospital where most of the population in the
Affiliates service area seeks breast health services beyond clinical breast exams and screening
and diagnostic services. The new Peyton Anderson Cancer Center will create less confusion for
patients by offering a one-stop shop facility for all cancer treatment, from screenings to
survivorship services. With everything in one place, patients will receive lower costs and be able
to receive quicker care.
Weaknesses of Macon-Bibb County include no mobile mammography units and limited
BCCP funding. A mobile mammography unit or transportation system would allow the hospitals
to extend services to surrounding rural areas to women who have trouble accessing treatment
and survivorship services due to distance. Since there is a high population of uninsured women
in Macon-Bibb, the health department experience strained funding for BCCP services, limiting
availability to screening and diagnostic mammograms to all eligible women.
A majority of the Affiliates existing partnerships are located in Macon-Bibb County. Many
of the organizations listed on the Health Systems Analysis are former or current grantees.
Some organizations have also sponsored Komen Central Georgia events. Partnerships in
Macon-Bibb are essential for the Affiliate to maintain because the county provides services to
patients in the Affiliates entire service area. There currently no existing partnerships in Monroe
County or Peach County. We have not awarded a community grant in either county. The nurses
and staff at the health departments and hospitals will serve as valuable resources in the future
to better understand the status of breast health services in those counties.
Georgia is not expanding Medicaid eligibility so many residents will remain uninsured
because they do not fall within Medicaid eligibility guidelines and their income tax is too high to
receive a health insurance premium tax credit through the Marketplace. Many women will
continue to rely on BCCP services and clinics to receive screenings. These facilities do not have
enough funds to provide services for the entire population. Also, NBCCEDP does not extend
coverage to men, causing major challenges for uninsured men diagnosed with breast cancer.

Treatment for patients who are diagnosed with breast cancer but who do not have health
insurance can be paid through Womens Health Medicaid for qualified applicants.
The Affiliate does not currently participant in Public Policy activities. The Affiliate will work
on sharing the 2015 Community Profile with local officials, city mayors, and county mayors to
inform them of the work and needs in the service area.