Issue link: https://www.ifoldsflip.com/i/1178734
a primer on ewc: free Breast anD cervical cancer screening for people in neeD s tatewide program EWC (Every Woman Counts) provides free breast and cervical cancer screening and diagnostic services to California's underserved populations. EWC's purpose is to save lives by "preventing and reducing the devastating effects of cancer…through public and provider education, early detection, diagnosis, case management, and integrated preventive services" (from EWC web site). EWC is part of the Cancer Detection and Treatment Branch of the California Department of Health Care Services (DHCS). According to a DHCS representative, EWC was created within the California Department of Health Services (DHS) in 1991. At its inception, the EWC program had 134 providers and provided services to approximately 30,000 women the first year. "Since that time, EWC providers have increased to approximately 900," says DHCS. According to data from Fiscal Year 2016-17, EWC provided breast and/or cervical cancer screening and diagnostic services to nearly 161,221 uninsured and underinsured women that year. Interested in researching online to determine if you are eligible for free breast and cervical cancer screening services? Visit the DHCS website, https://www.dhcs.ca.gov/ services/cancer/EWC, for the EWC program's eligibility criteria (includes income restrictions, having no or limited insurance, and residing in California). For breast cancer screenings, if a person has symptoms at any age, they may qualify for diagnostic services. If you don't qualify, the representative for your area may know of other low-cost screening programs (see web site). There are several Santa Cruz County providers who offer services through EWC. These include the Santa Cruz Community Health Centers (SCCHC, which includes the East Cliff Family Health Center and the Santa Cruz Women's Health Center) and Salud Para La Gente. Santa Cruz Community Health Centers Dr. Stephanie Macwhorter, Clinical Operations Director for SCCHC, offers information about both EWC's history and her Centers' offerings. "EWC evolved from what had been known as the BCEDP (breast cancer early detection program), which began in 1991 as a coordinated effort with a federal CDC funded public health program. The federal and state programs were combined in 2002 under a comprehensive title, Cancer Detection Program, which became EWC." As with many types of cancer, early detection of breast or cervical cancer can mean faster treatment or improved outcomes. "At risk populations include low income and medically underserved groups; these groups are more likely to lack health coverage and have less reliable access to medical information because they may face a variety of language, cultural and/or socioeconomic barriers to obtaining preventive cancer care and treatment," says Macwhorter. "By educating medical providers, communities, and patients about these services, we can help break down the barriers so that women in all communities can lead healthier lives. Statewide, between 2015-2016 (about 8,500) and 2016- 2017 (over 17,000), there was a 50 percent increase of women who were reached through EWC health education classes, small group sessions, one to one consultations and other community events. In 2015, the last available census data from EWC, this program led to the diagnosis of 699 women with breast and 34 women with cervical cancers. In 2016-2017, EWC provided over 140,000 breast cancer services to women between 21-65 and over 65,000 cervical cancer services to the same age bracket." "We began serving as an EWC provider in 1995, under our older clinic name, WomanKind," adds Macwhorter. WomanKind became the Santa Cruz Women's Health Center in 2003. They added East Cliff Family Health Center to their sites in 2014. If a patient is interested in EWC services through the SCCHC, they should call to set up an appointment. Patients will be screened for eligibility during an office visit (individuals have to complete forms that are scanned into the state system at the clinic). "EWC provides free clinical breast exams, mammograms and PAP tests to underserved women in California," says Macwhorter. "Our clinics have bi-cultural and bilingual community health workers who provide education, screenings and referrals as part of this service. In 2018-19, SCCHC provided 266 screening services under EWC and 2019-20 is trending to be slightly higher." Macwhorter says that EWC is available to all women, living in California, between the ages of 21-65 (dependent on screening needs or symptoms) and meeting simple income requirements. Citizenship or legal resident status is NOT required. Salud Para La Gente If someone wants to be seen at Watsonville's Salud Para La Gente for potential services through EWC, the first step is to call and "make an appointment with one of our medical providers," says Amy Ross, Director of Patient Services at Salud. "I want to highlight that the EWC program provides breast diagnostic services, regardless of gender— women and men are able to utilize this." In the past 12 months, Salud has served 922 unique patients through EWC. Salud first enrolled in the EWC program in 2005. Ross explains a few of the ways the program helps people, and how it has evolved: "EWC removes barriers, such as cost and navigating service coverage, for some of California's most under-served populations in seeking breast and cervical cancer preventative services," says Ross. "Over time, EWC has continued to expand access and services covered by the program. For example, diagnostic breast services are now available to both women and men, and as of 2017, symptomatic services have no age restrictions. This expanded coverage is hugely helpful to our patients who oftentimes have to make tough decisions between day-to- day living expenses and health expenses. This program supports patients in choosing their health." Routine breast and cervical cancer screening, says Salud's Dr. Cristina Gamboa, is an important component of well women care. Gamboa, director of ambulatory women's health, regularly sees patients at Salud. "I emphasize to patients that screening tests exist to find changes and/or 'pre- cancer' before cancer is present," she says. There are types of cancers that progress rapidly, she adds, but "the majority of breast and cervical cancers progress over time and screening tests are useful for detecting cancer precursors. Another benefit to routine screening is it allows us as health care providers to routinely perform risk assessments and counsel patients on how to have healthier lifestyles—which in turn can decrease the risk of cancers." Gamboa acknowledges that while screening tests themselves are meaningful, "when accompanied by a provider-patient discussion on their importance, we can make an even greater impact." "Breast and cervical cancer can be detected early and have a better chance of responding to treatment when found by a screening mammogram or pap smear with HPV testing, respectively," she adds. "Lower screening rates are associated with those who are uninsured, have gaps in their insurance coverage, or have no usual source of care. The Latinx and African American communities have the highest rates of being uninsured and also experience the greatest burden of disease, specifically breast and cervical cancers. Programs such as EWC that provide screening, despite one's insurance status or ability to pay, lessens the health disparities and makes our community healthier as a whole." If people are interested in signing up for EWC but need assistance, Gamboa encourages them to reach out to Salud. "We provide staff training and support to assist patients with enrollment," she says. "They are not alone. We acknowledge the effort it takes to be proactive in their health, and want to help the community members benefit from any programs they may qualify for." Recent History Over the past five years, several California bills that help the EWC Program were signed into law. AB 49 (Buchanan, Chapter 351, Statutes of 2014) authorized the DHCS to apply to the Department of Motor Vehicles to sponsor a breast cancer awareness license plate program. The California Breast Cancer Awareness license plate (also known as Pink Plate) was started by a group of Breast Cancer Survivors (the Survivor Sisters) in Northern California. They wanted to make a difference by promoting early detection and helping more women survive breast cancer. "As of September 2019, there were 5,453 license plates issued, of which 30 are motorcycle plates," shares a DHCS staff member. "All monies collected from the plates are used to provide direct screening and diagnostic services." Effective January 1, 2017, AB 1795 (Atkins, Chapter 608, Statutes of 2016) expanded EWC breast cancer screening services to include an individual of any age who is symptomatic, and low- income, underinsured, or uninsured. "The intent of the bill was to ensure women received timely access to necessary services to detect and treat cancers early," says DHCS. When asked how many women the EWC program serves, DHCS responded that, "In FY 2016-17 and FY 2017-18, the number of average monthly individuals served by the EWC program was 25,030 and 26,914, respectively. DHCS attributes the increases in part, to the passage of AB 1795." More Resources To find an EWC Provider, utilize the 24-hour EWC toll-free telephone provider locator at 1-800-511- 2300 (phone line includes representatives that speak more than 15 languages) or the online EWC provider locator at http://www.dhcs. ca.gov/services/cancer/ EWC/Pages/ewc-clinic- locator.aspx. The EWC Program has Regional Contractors (RC) throughout California who can provide information to individuals about breast and cervical cancer screening. To locate an RC, see http://www. dhcs.ca.gov/services/ cancer/EWC/Pages/ ewc-clinic-locator.aspx dhcs.ca/gov/services/ cancer/EWC/Pages/ RegionalContractors. aspx. RCs are also great links to support groups, advocacy groups and the latest information on what's happening in a specific community. Details: Every Woman Counts, Department of Health Care Services' Cancer Detection and Treatment Branch, Sacramento, CA, (916) 449- 5300, https://www.dhcs. ca.gov/services/cancer/ EWC/Pages/default.aspx Santa Cruz Community Health Centers (Call 831- 427-3500 for both sites): Santa Cruz Women's Health Center, 250 Locust St., Santa Cruz, www. schealthcenters.org/ services/santa-cruz- womens-health-center/ East Cliff Family Health Center, 21507 East Cliff Drive, Santa Cruz, www. schealthcenters.org/ services/east-cliff-family- health-center/ Salud Para La Gente, several locations in Watsonville, 831-728-0222, https://splg.org/ by Tara Fatemi Walker Jenny Yeaney, Paulina Uribe, Brenda Diaz , Julia Stevens, Kim Nguyen Kim Nguyen, Brenda Diaz, Paulina Uribe, Jenny Yeaney, Julia Stevens, Abby Imboden