Using Trusted Members of Community to Reduce Fear of Lung Cancer Screening

Once a week for four weeks last summer, Kita Mitcham gathered 25 of her friends, family and other members of the Good Hope Mission Baptist Church in Augusta, Georgia, to talk about lung cancer prevention and the benefits of early screening for the disease. Ms. Mitcham is one of about 45 community health workers who are educating nearly 500 people in 12 minority and underserved communities in the Central Savannah River Area (CSRA) about lung cancer prevention and screening.

Some of the nation’s worst cancer outcomes and disparities are found in Georgia, especially in the CSRA where minorities account for more than 50 percent of the population and 24 percent fall below the poverty level. In this region, high rates of smoking and exposure from nuclear and other industrial plants have translated into higher than average rates of lung cancer. About 500 new cases of lung cancer are diagnosed with lung every year in the CSRA and 380 people die from the disease. 

Ms. Mitcham is a community health worker trained by Georgia Regents University (GRU) Cancer Center’s cancer-Community Awareness Access Research and Education initiative, known as c-CARE. The project is funded by a $1.74 million, three-year grant from the Bristol-Myers Squibb Foundation’s Bridging Cancer Care™ initiative, which seeks to reduce the burden of lung cancer among minority and underserved populations in select southeastern U.S. states through innovative models of prevention, detection and education, and by helping people living with lung cancer access and navigate cancer care and community-based supportive services. 

Ms. Mitcham and her fellow community health workers present evidence-based, culturally relevant information about lung cancer prevention, screening and diagnosis to groups of their peers. They were selected by their pastors and other neighborhood leaders as trusted members of the community. What’s more, the approach and information presented to each community were developed through 

“New lung cancer screening guidelines were approved in 2013, but translating them into clinical practice can take five to seven years,” says Lovoria Williams, PhD, FNP-BC, associate professor, GRU Cancer Center and principal investigator for c-CARE’s lung cancer module. “Community engagement though the c-CARE program will go a long way in increasing awareness of the guidelines and getting people in for screening.”

c-CARE is being piloted in Augusta at seven African-American churches, four clinics and a large community recreation center. “Our model recognizes that it must work within the unique social and cultural framework of each community to have the desired impact,” Dr. Williams says. “c-CARE is designed, implemented, evaluated and sustained in partnership with trusted community partners.”

Community health workers recruit up to 50 of their peers and family members to participate in a four-week session. All participants from Ms. Mitcham’s site were from her church, including her mother-in-law and uncle, who were smokers, former smokers or had worked at one of the industrial plants in the area. “There is a lot of fear around cancer in my community,” she says.” It’s viewed as a death sentence, so it’s important that we educate people about its causes, how they can reduce their chances of developing it and let them know that if they meet the criteria for screening, early detection can help save their life.” 

Smoking cessation was a large component of the program, but lung cancer causes, incidence and risk factors were introduced as well. Each participant’s lung cancer risk was calculated and screening was offered to anyone who met the screening criteria. Navigation to tobacco cessation, cancer care and treatment services were available if needed. Although some people were hesitant about screening when they began the program, “once they learned more about it and why it was important, there was a tremendous response,” Ms. Mitcham says. 

The 12 sites have been separated into three cohorts. Programs at the four sites in the first cohort are complete and are launching in the second. Plans are to have all studies completed by the end of 2016. “We already see that community health workers are encouraging their program participants to begin smoking cessation, Dr. Williams says. “The conversations and discussions make them feel more connected and more willing to participate in managing their own health,” Dr. Williams says. 

Over time, the focus of c-CARE in the 12 communities will broaden to include other major preventable cancers, such as colon, prostate and breast cancer, and the program will expand to serve other communities with high concentrations of disparity populations.