A Cancer Education and Prevention Center

A Community Program

ROBERT J. SCHWEITZER, MD

The Cancer Education and Prevention Center at Samuel Merritt Hospital in Oakland, CA is one of the 27 American Cancer Society (ACS)-National Cancer Institute (NCI) breast cancer demonstration projects. In 1980 it was converted to a General Cancer Screening Clinic for men and women. Its goal is to not only detect cancer, but to teach patients about the most current methods of self-examination and surveillance. In addition, there is a thorough assessment of each patient’s risk factors for cancer, and attempts are made to assist them in altering life styles and habits by reducing potential for future cancer. Many community physicians perceived the hospital-based Screening Center as a potential duplication of medical services to their private patients. Several methods were used to solve this and other problems. Many innovative projects at the Center were used to promote both professional education and training to physicians and other health professionals, as well as public education for the community. Five thousand nine hundred thirty-four patients have been screened. There were 175 presentations to the community and 508 Clinic classes with 76 training sessions at the Center. A hospital-based Cancer Education and Prevention Center of this type can offer a service to the community and be a rich source of in-depth education for both professionals and for the public.

Cancer 62:1821-1822, 1988.

HE CANCER EDUCATION AND PREVENTION CENTER T is based at Samuel Memtt Hospital in Oakland, CA. It originally began in 1974 as one of the 27 nation- wide American Cancer Society (ACS)-National Cancer Institute (NCI) Funded Breast Cancer Detection Demonstration Projects. In 1980, through a generous grant from the ACS, CA Division, it expanded to a gen- eral cancer-screening clinic. Subsequently, the Center has been funded by the hospital and patients’ fees. The focus has been to not only screen patients for cancer, but to teach them the most current methods of self-exami- nation techniques and surveillance. In addition, there is a thorough assessment and evaluation of their risk fac- tors for developing cancer. A plan then is developed to alter habits and lifestyles to reduce the potential for fu- ture cancers.

The work of this Center initially led to problems with some community physicians, who perceived the Center as a duplication of medical services to their private pa-

Presented at the American Cancer Society Second National Confer- ence on Cancer Prevention and Detection, Seattle, Washington, June

From the Cancer Education and Prevention Center, Memtt/Peralta

Address for reprints: Robert J. Schweitzer, MD, 3232 Elm Street,

Accepted for publication December 16, 1987.

25-27, 1987.

Medical Center, Oakland, California.

Oakland, CA 94609.

tients. Some believed the screening at the Clinic might replace either the annual examination or the Pap smear performed at the physician’s office. In an effort to cor- rect these problems, personal interviews were made with key physicians to discuss the educational goals of the Center and make an assessment of the needs of the phy- sicians that might be addressed by members of the Center. It was apparent that most of the physicians did not have sufficient time to spend educating their pa- tients about methods of self-detection for cancer or for discussions with them to reduce the potential risks of cancer. Physicians also found it difficult and time-con- suming to help their patients to stop smoking, and to give them the necessary continuing follow-up as to their progress with this endeavor. By offering the physicians these and similar services for their patients, and under- scoring the educational aspects of our program, we were able to establish a better rapport with the community’s physicians. All patients screened in the Center were promptly referred back to their physicians with full re- ports as to the findings.

The subsequent workup and any decision as to ther- apy were made completely by the primary-care physi- cian. Members of the Center were available for infor- mation or consultation as needed. Careful follow-up of patients with positive findings was mandatory to insure that patients would actually report back to their family physicians.

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A minigrant from the ACS, California Division, was obtained to study the type of Cancer Screening Educa- tion that is provided in the medical schools, as well as to determine the type of knowledge that faculty members and postgraduate residents in training had in reference to Cancer Screening and Prevention. Although the ACS believes that every doctor’s office is a cancer-screening clinic, this is not necessarily taught in physicians’ formal medical education. Physicians have not been educated to follow the many guidelines and recommendations that have been formulated by the ACS. There is also a definite gap between the education that patients might receive through classes, literature, and the media and what the health-care system and the patient’s physician actually provided.

As a follow-up of this study and in an attempt to enhance the image of the Center with the professional community, professional education was provided with a series of lectures and classes presented to physicians, to medical-office personnel, and to patients. The lectures included such topics as oral cancer, smoking cessation, cancer prevention, breast cancer risks, skin cancer risks, diet and prevention, and the understanding of AIDS. Similar lectures on cancer risks and risk reduction and cancer prevention were given at Grand Rounds and various staff meetings with explicit descriptions of the services available at the Cancer Education and Preven- tion Center.

One of our most successful programs has been the tutorial colorectal sigmoidoscopy classes offered to the physicians. These physicians were able to schedule their own private patients in the Center, and were given per- sonal instruction and hands-on experience as to the use of the 65-cm flexible sigmoidoscope. Training was given in sufficient depth to enable them to eventually perform this examination in a competent manner. Purchase of a video sigmoidoscope by the Center enhanced their training. Initially, instructions were given free. Cur- rently, a modest fee is charged. These tutorial sessions are very popular and appreciated by the professionals attending them.

A dedicated Mammographic Screening Unit, funded by the hospital radiologists, recently was installed on the Center premises. This provided an important means of low-cost screening to the patients. In addition, it estab- lished a cost-sharing basis and a good working relation- ship with the radiologists involved. Routine screening mammography was offered to the physicians for their patients. The patients were given an opportunity to have

an option of breast self-examination by Center person- nel and instructions in breast self-examination, and if they so desired, to go through the general Cancer Screening and Education process. Some elect just to have the screening mammograms. All interpretations of the mammograms are made personally by the radiolo- gists, and the reports are immediately forwarded to their own physicians.

Initially, the Pap smear was a routine part of the screening examination. To avoid duplications of medi- cal services done in the physicians’ offices, the decision was made to not do the Pap smear in the Clinic. Instead, during the screening process, the need to have this ser- vice done by their private physician is underscored. Where the Pap smear has not been performed, it is pro- vided at the Center.

Workshops in the methods and techniques employed for screening and education are conducted for allied medical personnel. Consultation with institutions inter- ested in setting up similar screening centers are available at the Center.

Skin cancer screening day is held annually in May. It is a major project in cooperation with the Department of Dermatology at Merritt/Peralta Medical Center. Ten dermatologists devote a full day to skin screening for interested members of the community. There is no charge for this service. When it was held the first time, 160 patients were screened. Seventeen basal cell cancers, 70 premalignant lesions, three leukoplakias, and one fungal infection were detected. At the second annual skin screening, 264 patients were screened.

The Merritt/Peralta Foundation has funded several projects, enabling us to make various video presenta- tions on cancer risks and methods of self-detection. The video tapes are continually used at the Center, and are available for rent or purchase. They are often shown to patients in the Reception Area before the screening ex- amination.

Since 1985, 5934 patients have been screened. There have been 175 presentations made to the community and 508 classes were conducted at the Clinic. Seventy- eight training sessions also have been conducted at the Center.

In conclusion, a hospital-based Cancer Education and Prevention Center of this type not only offers a service to the community, but will be a rich source for in-depth education to professionals and to the public. Education, however, does not generate any significant revenue and the staff must be creative in generating new low-budget ideas for marketing and reaching consumers.