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A doctor reviews a mammogram and checks for breast cancer.
Katie Manga, CEO of the nonprofit Gateway to Hope, remembers a patient’s story, a woman who went to a mammography van four times but couldn’t bring herself to get the screening.
“She was fearful of whether it would hurt, she was fearful of what the outcome would be, even though she had a lump that was almost protruding. She knew that there was something bad happening,” Manga says. “What made a difference was sitting down and really listening to her story, and having some empathy for where she was coming from. She was able to say, ‘I know you understand where I’m coming from because you live here, too.’ She went to that screening, she sought treatment, we helped her through the entire process, and she is now cancer-free.”
Whereas COVID-19 has revealed health disparities some never knew existed, Gateway to Hope has witnessed them in breast cancer patients—in women ages 18–45, a black woman in St. Louis County is four times more likely to die from breast cancer than a white woman. Gateway to Hope assists women with breast cancer whose annual income is at or below 4.5 times the federal poverty rate by pairing patients with advocates who can help them with financial, emotional, and service-based needs. And they aim to rebuild trust in communities. “If you’re coming from a community where there is a history of mistreatment because of the color of your skin, both recent and long-ago history, you're still going to go, ‘I don’t know if I want radiation,’” Manga says. “That’s a big role that we play, even on an individual basis, with every patient who we meet. We help them articulate what their questions are, what their concerns are, and we help them feel empowered to be able to walk into their physician’s office and ask them questions and get the answers that they need.”
Breast Cancer Awareness Month is October. Due to COVID-19, Gateway to Hope can’t host its traditional gala, but they will be hosting a virtual campaign beginning October 1. Here, four questions for Manga about the pandemic and breast cancer.
What has been the effect of COVID-19 on women accessing preventative care?
I think it’s a crisis within the crisis. In the months between March and June, mammography in the United States dropped off by 95 percent. Where we were seeing 13,000–14,000 mammograms a day in the U.S., we dropped down to about 500 a day. That’s just because those services shut down. So whether you had the resources or not to access your screenings, you just couldn’t get them. That now lingers. You have facilities that have huge backlogs and patient numbers that they have to work through, and—let’s be real—people are scared and not sure if it’s even safe to go. The result of that is, and I actually saw this in a Kaiser Health News piece just in the last week or so, there’s an estimated 40,000 undiagnosed cases of breast cancer in the United States today.
That must make your job much harder.
In the past 30 years, we’ve made significant progress in mortality rates for women with breast cancer. The disease, if caught soon enough, has a 90-percent-plus cure rate. This could erase 30 years of progress.
Who will this affect the most?
The people who will be impacted the most are the people who have a harder time accessing screenings during normal times, which are women of color and people who are low-income. It’s something that we're, frankly, gearing up for six months to a year from now, and we fully expect to see our patient numbers increase significantly. Layer on top of that the fact that people have lost insurance and have lost income. We’re going to see more women with late-stage disease and more financial stressors. What I’m really trying to do for Gateway to Hope is to get into a position to do everything we can to respond to that in the long-term, and, in the interim, do what we can to provide community education, to do the outreach to find women today who should be getting their screenings and help get them to those treatments.
What does that long-term response look like?
It’s a combination of things—it’s definitely fundraising and trying to fundraise ahead of need, which, of course, is its own challenge right now because we know people are hurting. It’s harder to make a donation today because of the way the economy is. And we typically have relied heavily on fundraising events, and we can’t host in-person events. We’ve had to pivot our fundraising quite a bit, but also our programming. Patients with late-stage disease have different needs. There are things like prolonged grief, considering, potentially, end-of-life questions that you never thought you would be pondering. The physical toll that treatment takes on your body when you’re late-stage is much higher. You’re going to be out of work longer, you’re going to have a hard time caring for your children if you have young children, and so on. We’re really thinking about starting to put some things in place with our programming and how we provide that emotional support and financial support for patients with later-stage disease.
