By Dr. Markus Holzhauer

After many years of discussion around what it would take to offer mammography to the many underserved women in our community, Windsong Radiology Group, PC (Windsong) is now, literally, driving early detection throughout the eight counties of Western New York. As a provider of mobile breast cancer screening, Windsong is eliminating barriers to breast cancer screening in communities with limited or no access to it.

This initiative was made possible by Governor Andrew Cuomo’s Breast Cancer Screening Initiative. Windsong participated in the Request for Proposal and was one of 6 grantees in the “Get Screened, No Excuses” initiative, designed to meet more than 32,000 women in New York State. As a proud recipient of funding from this initiative, via the NYS Department of Health and Health Research Inc.’s (HRI) Mobile Mammography Van grant, Windsong now works collaboratively with churches, payors, community and healthcare partners to improve breast cancer screening rates in all eight counties encompassing Allegany, Erie, Cattaraugus, Chautauqua, Wyoming, Niagara, Orleans and Genesee. Windsong, long a leader in breast imaging, with four freestanding breast imaging facilities, now looks beyond its horizon to serve women that could not be reached by traditional brick and mortar locations.

Getting here has not been easy. Over several months the Windsong mobile mammography coach team worked diligently selecting the van and equipment necessary to meet the standards of our Windsong brand. High quality and a superior patient experience have become synonymous with Windsong. Considerations were made thinking about long term goals. Subsequently, we selected a 45-foot tractor trailer to allow for a spacious interior and high-quality experience that could accommodate an exam room for provider clinical breast exams.

Bad weather in January 2018 delayed the delivery of the mobile mammography coach from Arizona. A decision to delay the official launch seemed appropriate given the long, snowy, and bitter cold winter we were having. Delaying our ribbon cutting event until April seemed a wise decision, yet it ended up being held on the windiest day of the year, with the tent that was to house our party completely destroyed by 60 mph gusts. Not a problem, however, as the venue moved the party indoors and over 80 staff, community partners, and representatives from our Amherst Chamber of Commerce helped us to celebrate our ability to remove barriers to access for the many underserved women in our community. A Facetime video of the ribbon cutting received considerable social media attention from our community. Radio and TV interviews streaming on social media continue to help promote the mobile coach.

Purchasing through a grant was certainly a learning process. Our for-profit organization needed to acclimate to bureaucracy of a government funding agency. We learned early on that we would have to work under the strict oversight of the funding agency and our deadlines were necessarily pushed out. This included all aspects of the mobile mammography coachpurchasing decisions including approval of marketing and media campaigns.

To align with Windsong’s high quality standards, the mobile mammography coach offers Windsong’s standard Hologic 3D mammography (digital breast tomosynthesis). As one of the first free-standing breast imaging facilities in the area to offer this technology, we have long been committed to using state of the art technology to improve early detection of cancer and reduce recall rates. Having the same technology on the mobile coach enables us to cover time off easily. In total, Windsong hired six new staff to support this important initiative.

During the launch of the mobile coach, Dr. Thomas Summers, president of Windsong announced, “This aggressive breast cancer screening initiative eliminates barriers to screening in an effort to improve access to a vital service.” It is paying huge dividends to the women that have been screened. Thus far, the mobile mammography team has served nearly 500 women over the course of 3 months. Windsong has already detected cancer at a rate three times what we would anticipate in a normal screening environment. We attribute this to the fact that many of these women have either never been screened or are not being screened regularly. The ability to detect cancers early and give women the ability to treat their cancers when they are most easily treated has provided an incredibly positive and rewarding experience.

This initiative has not come without its challenges. The other grant awardees are hospital systems with built in primary care services to assist with follow up. Although we have an impressive patient navigation system in place, the absence of primary care has made it difficult to serve patients that present without a script. Although having a nurse practitioner to write scripts has not been an issue, identifying an NP with an overseeing physician has been a great challenge to our organization.

Another area of consternation has been trying to educate the underserved women that are less likely to be screened. It is difficult to dispel the myths surrounding breast cancer screening and educate women who fear that if they have been asked to return for additional imaging, they surely have cancer. Many underserved women are reluctant to return for their additional imaging because of this fear of a cancer diagnosis or concern over cost.

Identifying partners that have already gained trust in the communities you wish to serve is paramount to the success of the mobile initiative. Interaction with the target population, communicating effectively, and working collaboratively with community partners cannot be overemphasized enough.

Jamie Stasiak, the mobile mammography program coordinator says, “We have learned a thing or two along the way. It is imperative that you research every aspect of the initiative thoroughly.” Our team learned that regardless of our preparation, there are things that you can’t plan for until you are in motion. Flexibility is key. Jamie added, “The team must be willing to conduct the outreach in the underserved communities and improvise as needed.”

A case in point was that we learned quickly that the size of our mobile coach limited access on a variety of rural and urban roadways. A 45-foot tractor trailer provides ample space for a breast cancer screening mobile environment, but it also limits where you can travel and park. We have done our best to improvise where possible.

As the medical director of this rewarding initiative, I can tell you that selecting a strong team consisting of a mammography technologist, program coordinator and program assistant makes all the difference. Diversity within your staff or your community partners and cultural sensitivity training are a must. Strong leadership that has the ability to resolve issues and work collaboratively with the community at large creates an environment that can overcome barriers for the women we wish to serve. We have great pride in this initiative and highly recommend that other breast imaging facilities do their best to reach the underserved women in their communities.

About the author: Dr. Markus Holzhauer is a breast imaging radiologist and the mobile mammography medical director for Windsong Radiology Group, PC.