Mission Action Plan

Breast Health and Breast Cancer Findings of the Target Communities

Quantitative Data Summary
The Quantitative Data report measured the breast cancer impact in the Komen Central Georgia
service area. Data were collected from many credible sources. The results of the collected data
were used to identify the highest priority areas in the service areas.
Breast Cancer Incidence, Death, and Late-stage Diagnosis
Overall, the breast cancer incidence rate in the Komen Central Georgia Affiliate service area
was slightly lower than that observed in the US as a whole and the incidence trend was lower
than the US as a whole. The incidence rate and trend of the Affiliate service area were not
significantly different than that observed for the State of Georgia.
Overall, the breast cancer death rate in the Komen Central Georgia Affiliate service area was
slightly lower than that observed in the US as a whole and the death rate trend was not
available for comparison with the US as a whole. The death rate of the Affiliate service area was
significantly lower than that observed for the State of Georgia.
Overall, the breast cancer late-stage incidence rate in the Komen Central Georgia Affiliate
service area was slightly higher than that observed in the US as a whole and the late-stage
incidence trend was higher than the US as a whole. The late-stage incidence rate and trend of
the Affiliate service area were not significantly different than that observed for the State of
Georgia.
Breast Cancer Screening Rates
The breast cancer screening proportion in the Komen Central Georgia Affiliate service area was
not significantly different than that observed in the US as a whole. The screening proportion of
the Affiliate service area was not significantly different than the State of Georgia.
None of the counties in the Affiliate service area had substantially different screening
proportions than the Affiliate service area as a whole.
Population Characteristics
Proportionately, the Komen Central Georgia Affiliate service area has a substantially smaller
White female population than the US as a whole, a substantially larger Black female population,
a substantially smaller Asian and Pacific Islander (API) female population, a slightly smaller
American Indian and Alaska Native (AIAN) female population, and a substantially smaller
Hispanic/Latina female population. The Affiliates female population is slightly younger than that
of the US as a whole. The Affiliates education level is slightly lower than and income level is
slightly lower than those of the US as a whole. There are a slightly larger percentage of people
who are unemployed in the Affiliate service area. The Affiliate service area has a substantially
smaller percentage of people who are foreign born and a substantially smaller percentage of
people who are linguistically isolated. There are a substantially larger percentage of people

living in rural areas, a slightly larger percentage of people without health insurance, and a
substantially larger percentage of people living in medically underserved areas. Peach County
has the lowest screening rate, and it is the only county to show a rising incidence rate. The
screening rate within the Komen Central Georgia Affiliate service area is significantly lower than
that observed for the State of Georgia.
Healthy People 2020 Forecasts
Because death rate trend data are not available for the Komen Central Georgia Affiliate service
area, it can't be predicted whether the Affiliate service area will meet the HP2020 target of 20.6
female breast cancer deaths per 100,000.
Because data were not available and data for small numbers of people are not reliable, it cant
be predicted whether Baldwin County, Crawford County, Jones County, Monroe County, Peach
County and Twiggs County will reach the death rate target. The remaining counties are likely to
achieve the target by 2020 or earlier.
The Komen Central Georgia Affiliate service area as a whole is likely to miss the HP2020 latestage incidence rate target. The Affiliate service area had a base rate of 47.8 new late-stage
cases per 100,000 females per year from 2006 to 2010 (age-adjusted). This rate coupled with
the recent late-stage incidence rate trend, indicates that the Komen Central Georgia Affiliate
service area is likely to miss the HP2020 target of 41.0 new late-stage cases per 100,000.
The following counties are likely to miss the HP2020 late-stage incidence rate target unless the
late-stage incidence rate falls at a faster rate than currently estimated: Jones, Macon-Bibb,
Monroe, and Peach Counties
Because data for small numbers of people are not reliable, it cant be predicted whether Twiggs
County will reach the late-stage incidence rate target. The remaining counties are likely to
achieve the target by 2020 or earlier.
Selection of Target Counties
Based off the findings of the Quantitative Data Report, the following counties were selected as
Targets: Macon-Bibb, Monroe, and Peach. Komen Central Georgia will focus strategic efforts on
these counties over the course of the next five years. Selected target counties demonstrate key
indicators showing an increased chance of vulnerable populations likely at risk for experiencing
gaps in breast health services and/or barriers in access to care.
Macon-Bibb County is a high priority county due to the amount of time needed to meet the
Healthy People 2020 goals; it will take 13 years or longer to achieve the incidence rate goal and
at least seven years to achieve death rate goal. Macon-Bibb County is the metropolitan center
of the Central Georgia service area and provides more available services compared to the other
counties in the service area. A high percentage of Macon-Bibb citizens (45.3%) live below the

Central Georgia Affiliate of Susan G. Komen

poverty level and require access to reduced or no-cost breast services. Additionally, there is
substantially higher percentage of underserved black females that live in Macon-Bibb County.
Monroe County is considered a target county because a majority of the county is rural (80.2%)
and is categorized as medically underserved (100%). Monroe County has been identified as a
highest priority area due to the amount of time needed to meet the Healthy People 2020 goals;
it will take 13 years or longer to achieve its late-stage reduction target.
Like Monroe County, a majority of the residents in Peach County live in rural areas and are
considered medically underserved. A high percentage of the population lives below the poverty
level (41.7%). Also, a low percentage of women reported receiving recommended screenings in
the service area. Specifically, 66.8% received a mammogram in the last two years. Among
these women, there is a substantially high percentage of black females (48.9%). Peach County
is the only county in the service area to show a rising incidence rate. Peach County has also
been identified as a highest priority area due to the amount of time needed to meet the Healthy
People 2020 goals; it will take about 13 years or longer to achieve its late-stage reduction
target.
Health Systems and Public Policy Analysis Summary
Overall, the Central Georgia Affiliate service area has facilities and organizations that provide
services across the entire continuum of care and each target county receives limited federal
funding through the BCCP program to offer qualified women free services. However, the Health
Systems Analysis reveals there are major gaps in access to care within the target counties.
Monroe and Peach County each have one health department which offers clinical breast exams
and one hospital that offers screening and diagnostic mammograms and ultra-sounds. These
services are limited. There are no additional diagnostic services and absolutely no treatment or
survivorship services in these two counties. There are no nurse navigators at the county
hospitals. Patients must rely on their doctor to direct them to treatment. If someone is diagnosed
with breast cancer they are usually referred to either a hospital in Macon-Bibb County or to the
hospital in Houston County. Houston County is a reasonable drive from Peach County, but Bibb
County is not within reasonable driving distance from either of the counties. The lack of local
breast health services in Peach and Monroe Counties creates a major burden to breast cancer
patients or survivors who have been diagnosed with breast cancer and need further medical
attention or support services. Poor breast health outcomes, such as high mortality and high
incidences of late-stage diagnosis could be related to lack of access to care within each county.
Macon-Bibb County has accessibility to and quality care available; there are services across the
entire continuum of care in Macon-Bibb. There is a community health center, a volunteer clinic,
and a health department providing screening services and referrals for screening
mammograms. There are two major hospitals offering breast health services across the entire
continuum of care. A recent strength of Macon-Bibb County is the opening of a new cancer
center in November 2014 at the major hospital where most of the population in the Affiliates

Central Georgia Affiliate of Susan G. Komen

service area seeks breast health services beyond clinical breast exams and screening and
diagnostic services. The new Peyton Anderson Cancer Center will create less confusion for
patients by offering a one-stop shop facility for all cancer treatment, from screenings to
survivorship services. With everything in one place, patients will receive lower costs and be able
to receive quicker care.
Weaknesses of Macon-Bibb County include no mobile mammography units and limited BCCP
funding. A mobile mammography unit or transportation system would allow the hospitals to
extend services to surrounding rural areas to women who have trouble accessing treatment and
survivorship services due to distance. Since there is a high population of uninsured women in
Macon-Bibb, the health department experience strained funding for BCCP services, limiting
availability to screening and diagnostic mammograms to all eligible women.
A majority of the Affiliates existing partnerships are located in Macon-Bibb County. Many of the
organizations listed on the Health Systems Analysis are former or current grantees. Some
organizations have also sponsored Komen Central Georgia events. Partnerships in Macon-Bibb
are essential for the Affiliate to maintain because the county provides services to patients in the
Affiliates entire service area. There currently no existing partnerships in Monroe County or
Peach County. We have not awarded a community grant in either county. The nurses and staff
at the health departments and hospitals will serve as valuable resources in the future to better
understand the status of breast health services in those counties.
Georgia is not expanding Medicaid eligibility so many residents will remain uninsured because
they do not fall within Medicaid eligibility guidelines and their income tax is too high to receive a
health insurance premium tax credit through the Marketplace. Many women will continue to rely
on BCCP services and clinics to receive screenings. These facilities do not have enough funds
to provide services for the entire population. Also, NBCCEDP does not extend coverage to men,
causing major challenges for uninsured men diagnosed with breast cancer. Treatment for
patients who are diagnosed with breast cancer but who do not have health insurance can be
paid through Womens Health Medicaid for qualified applicants.
The Affiliate does not currently participant in Public Policy activities. The Affiliate will work on
sharing the 2015 Community Profile with local officials, city mayors, and county mayors to
inform them of the work and needs in the service area.
Qualitative Data Report
The qualitative data collection focused on barriers to screening, diagnosis, and treatment for
individuals in the three target counties indicating high concentrations of Black females,
medically underserved populations, and high late-stage diagnosis and death rates. While
Komen Central Georgia recognizes the uniqueness of Macon-Bibb, Monroe, and Peach
Counties, the qualitative data process revealed that these three counties are experiencing
similar barriers and challenges related to accessing breast health information and services.

Central Georgia Affiliate of Susan G. Komen

Overall, qualitative data collection suggests the high late-stage diagnosis rates may be related
to issues in access to services (cost and proximity), lack of breast health education and
knowledge, lack of knowledge on available services and resources, and lack of transportation to
get to those services.
Lack of transportation is a common barrier among all three target counties. Health care
resources differ across target counties. One hundred percent of the population living in Monroe
and Peach Counties are considered medically underserved. Participants in Monroe and Peach
Counties described having to travel to Macon-Bibb County for treatment or support services.
Macon-Bibb County is the only target county offering public transportation. This makes getting to
doctors appointment difficult and may cause missed appointments or disregard for scheduling
an appointment. Key informants in Macon-Bibb and Monroe Counties said a mobile
mammography unit would be convenient and beneficial to individuals without personal
transportation living in rural counties.
Another common barrier discussed was the lack of knowledge of available services and
resources. Individuals in all three counties need more information about screening, diagnostic,
and treatment opportunities that are available and accessible. Many women are discouraged
from going to the doctor for breast health services because they cannot afford the cost of
services. However, many of these women are unaware of local programs that offer free or
reduced costs mammograms and additional services.
Additionally there are a lot of issues with access to breast health and breast cancer services.
First, there is a lack of proximity to services. In the Komen Central Georgia service area, 45.6
percent of the population lives in a medically underserved area. Second, the cost of breast
health and breast cancer services scares many women. Uninsured women are unaware of
assistance programs available to them.
Finally, there is a lack of breast health and breast cancer education in our target counties.
Individuals living in target counties need educational opportunities related to breast health and
the benefits of screening and early detection. There are often language barriers between the
doctors and Hispanic patients. Education materials may not be offered in someones language.
Education literature also forms a problem as there is a high illiteracy rate in our service area.
Doctors may give a patient literature about breast cancer, but it does not help if they cannot
read it.

Central Georgia Affiliate of Susan G. Komen

Mission Action Plan

Problem Statement 1: Macon-Bibb, Monroe, and Peach counties are unlikely to meet HP2020
targets for both breast cancer mortality and late-stage incidence.
Priority 1: Strengthen grant programs that use evidence-based approaches to building
programs that result in positive changes in early screening and/or reduces rates of late stage
diagnosis
Objective: By September 2015, establish a Community Grants Committee consisting of at
least 3 members, including the Mission Coordinator that continually cultivates new
opportunities for funding in the Komen Central Georgia service area.
Objective: In 2016, reestablish the Small Grants program and write a Request for Applications
that highlights the need for innovative programs in Macon-Bibb, Monroe, and Peach counties.
Priority 2: Increase breast self-awareness and knowledge of available community services
throughout the service area.
Objective: By March 2016, develop a publicly accessible and accurate resource guide of
breast health services that meet the identified community needs and promote the availability
of the resource to the public.
Objective: By March 2016, organize and form an Education Committee consisting of at least 3
members, including the Mission Coordinator to meet at least 4 times per year.
Objective: By March 2017, organize and host a volunteer orientation to expand accurate
messaging at outreach opportunities throughout the Komen Central Georgia service area.
Objective: By March 2017, develop and implement methods to disseminate breast selfawareness resources that facilitate a greater reach and understanding of breast health among
patients/constituents to providers and public facilities in each of the counties in the service
area.
Objective: By March 2018, develop and implement a mobilized education series to promote
self-awareness education and available resources in target counties.
Priority 3: Diversify grants to include programs that promote a healthy lifestyle to reduce ones
risk of breast cancer and/or improve support services for breast cancer survivors within the
healthcare continuum.
Objective: By October 2016, contact 5 Affiliates with a history of funding programs that
promote healthy lifestyle choices to reduce ones risk of breast cancer.
Objective: By March 2017, reach out to at least 3 nonprofit organizations and discuss
opportunities for funding programs that empower individuals to make healthy lifestyle choices
to reduce one s risk of breast cancer.
Objective: Beginning in September 2015, solicit evidence-based grants that address support
services for specific populations of survivors, i.e. young women, metastatic, men, etc.
Objective: By March 2016, develop and implement a quarterly enewsletter for survivors,
including topics addressing local wellness opportunities, up to date information about
accessible support services, and notifications of recent Komen research advancements.
Objective: By March 2017, organize and execute an ongoing outreach activity targeted
towards breast cancer survivors in the service area.

Central Georgia Affiliate of Susan G. Komen

Priority 4: Strengthen collaborative relations throughout the service area to identify advocacy
opportunities that address community needs identified in the community profile.
Objective: By March 2016, Komen Central Georgia representatives will meet with a minimum
of 3 elected officials to discuss Community Profile results as well as budget and policy action
items related to increasing screening and access to care for breast cancer
Objective: By March 2017, work with all Georgia Affiliates and Georgia cancer coalition
organizations to promote national Komen advocacy priorities.
Priority 5: Fund programs that improve access to the entire continuum of care
Objective: By October 2016, identify community partners who can improve transportation to
services from Monroe and Peach.
Objective: Prioritize transportation assistance grants in the FY16 and FY17 Community
Grants and Small Grants cycle.
Problem Statement 2: African Americans, Latinas and uninsured and underserved populations
have limited access to culturally competent health care services, especially screening and
breast health education resources.
Priority: Partner with community-based organizations to promote breast self-awareness and
available services which reduce socioeconomic status, cultural, and/or language barriers.
Objective: By March 2017, distribute specific breast health information to populations that fall
at or below the federal poverty level in the service area through efforts unique to that
populations needs.
Objectives: By March 2016, reintroduce the Circle of Promise program and recruit at least 5
ambassadors per target county annually.
Objective: By March 2017, explore opportunities and partnerships for a Worship in Pink
program.
Objective: By March 2017, establish a presence and partnership with the Hispanic community
to promote effective dissemination of information and services to Latino women.
Priority: Reduce the rate of late-stage diagnosis among African Americans and Latinas in the
Komen Central Georgia service area.
Objective: Prioritize funding grant programs that are both culturally relevant and aim to
eliminate cultural barriers that preclude individuals from receiving information and from
accessing breast cancer screening and treatment beginning in the 2016 Community Grants
cycle.
Objectives: By October 2016, meet with at least two new community-based organizations in
Macon-Bibb, Monroe, and Peach counties to discuss potential partnerships and opportunities
for funding to decrease socioeconomic status, cultural, and/or language barriers.

Central Georgia Affiliate of Susan G. Komen