1. YWCA struggles to bring women in for
breast cancer care
LAFAYETTE, Ind. — After her mastectomy, she used the same specialty bra
for 13 years. In fact, the Amish woman wore it and her breast
prosthesis only to church so she could keep them in good condition. But the
bra couldn't last forever.
Another woman was battling breast cancer when her oncologist told her she
needed to stop working and take care of herself. As a single mother and the
sole provider for her family, the 45-year-old could not fathom quitting her
job and affording gas to travel 60 miles round-trip multiple times a week to
her medical appointments.
Although their experiences with breast cancer differ, one program provided
both of them support when they had no other options.
The YWCA of Greater Lafayette Women's Cancer Program helped the
women receive financial aid and resources that improved their quality of
life, said Heidi Kauffman, the program's director.
Last year, the program provided services to more than 1,400 women. It's a
significant shift from five years ago, when it helped nearly 2,400.
Despite the drop, officials suspect many local women still need financial
assistance for cancer care and are unaware of the screenings, treatment and
services they could receive for free.
“I know there's a lot of women out
there who still need us.”
Heidi Kauffman, director of the YMCA of Greater
Lafayette Women's Cancer Program

2. About 100 women are diagnosed with breast cancer each year in
Tippecanoe County, according to the National Cancer Institute. It's only one
of 23 counties in western Indiana that the Lafayette YWCA's program serves.
The annual rate across the counties totals 760.
"I know there's a lot of women out there who still need us," Kauffman said.
The events, fundraisers and plethora of pink ribbons for Breast Cancer
Awareness Month in October help raise attention for the program's offerings,
she said, but that awareness doesn't remain strong throughout the year.
People have called the cancer program's office in November asking if it's still
open, she noted.
Kauffman believes the increased screening coverage now available through
the Affordable Care Act, along with the lack of education about risk factors
associated with breast cancer, is affecting the number of women who seek
aid.
But the question of how to make more women, especially those who don't
seek regular medical care, aware of the program's offerings remains a
tricky puzzle the center is determined to solve.
"The low-hanging fruit has been picked and now all the people who never
see the doctor, never go to the doctor, theyʼre still out there and weʼre still
trying to figure out a way to get them in," Kauffman said.
Coverage expanded, services underutilized
The Lafayette area is armed with an abundance of resources for women
across the region who need financial and social services.
"If people are unemployed or underemployed and so the household budget
is really tight … these organizations can help," said Dr. Neil Estabrook, a
radiation oncologist at the IU Health Arnett Cancer Center in Lafayette. "As
a new doctor here in this community, Iʼm really impressed by the resources

3. that the Lafayette area has."
He said the center treats six to 12 breast cancer patients each year who
need financial assistance. It will then plug those patients into the
YWCA Women's Cancer Program.
Loved ones who lost their battle to cancer are
remembered paper bag lamps during Pump for Pink
Saturday, October 1, 2016, at Club Newtone, 725
Sagamore Parkway North in Lafayette.
(Photo: John Terhune/Journal & Courier)
The St. Elizabeth Breast Center in Lafayette also partners with the YWCA.
The program is part of the Indiana Breast and Cervical Cancer Program, the
state's implementation of the Centers for Disease Control and
Prevention's National Breast and Cervical Cancer Early Detection Program.
The Indiana Breast and Cervical Cancer Program provides funding for breast
and cervical cancer screenings, diagnostic testing, and treatment
to underserved and underinsured women who qualify for services.
For the uninsured, mammograms cost about $100 and a mastectomy could
run anywhere from $15,000 to more than $50,000, according to
CostHelper.com.

4. The state's program can provide full financial coverage for women whose
gross income places them at 200 percent of the federal poverty level. For
example, a woman who makes $23,760 annually could qualify for free
services. The rate rises to $48,600 for a family of four.
"There's a lot of people who make that (amount) who assume that they do
not qualify for the program and actually they do," Kauffman said.
“If people are unemployed or underemployed and so
the household budget is really tight … these
organizations can help.”
Dr. Neil Estabrook, radiation oncologist at
Indiana University Health Arnett Cancer Center
Two other levels of financial support are offered through the YWCA for those
who fall even further outside the federal poverty level.
Funds from the Indiana Breast Cancer Awareness Trust's specialty license
plates also flow into the YWCA's assistance program. Women at 275 percent
of the poverty level qualify for the funding, so a single woman with a
$32,670 annual income could qualify. It also could cover a family of four that
makes $66,825.
The YWCA and Susan G. Komen Central Indiana offer the highest financial
support at 400 percent of the poverty level. A single woman who makes
$47,520 or a family of four with a $97,200 income could access free
services.
Kauffman said the Affordable Care Act enabled the YWCA to boost
its support level because the law expanded coverage for breast and cervical
cancer screenings. Many women sought the program's financial assistance

5. for the screens before the ACA, she said.
The ACA mandates health care plans that started after Aug. 1, 2012,
offer mammograms without a co-pay or deductible to women 40 and older,
according to the American Cancer Society. It also requires plans that started
after Sept. 23, 2010, cover cervical cancer screening tests.
"When I started with this program five years ago, we helped 2,373 women
that year. Last year, we helped 1,427," Kauffman said. "Thatʼs because of the
Affordable Care Act."
Next Slide
Now, she and her team face a larger challenge: They need to bring uninsured
women and those who don't receive regular checkups through its doors.

6. About 27 percent of uninsured women 40 to 64 years old in Tippecanoe
County were at or below 200 percent of the poverty level in 2014, according
to U.S. Census Bureau estimates. The rate climbed above 30 percent for
women in nearby Carroll and Clinton counties.
"So where are those women? Thatʼs always my struggle is how do I find
those women," Kauffman said.
The YWCA has successfully helped many uninsured and
undocumented women, she noted.
For instance, one of its two patient navigators — who advocate for and guide
women during their cancer treatments — quickly helped an undocumented
woman receive free breast cancer treatment at an Indianapolis hospital
with a charity care program.
Now, the YWCA is using grass-root efforts to find women in need, Kauffman
said.
Staff are asking women they work with to tell their friends and family about
the program and what it can offer, she said. They're also reaching out to
health care providers directly and giving them brochures to ensure they're
spreading the word to their patients.
"That's who people trust," she said.
Common misconceptions
The program also suspects more women would seek its services if it weren't
for the many myths surrounding breast cancer testing.
The lack of education on breast cancer regarding the age women should
start receiving mammograms and who is most at risk for the disease keeps
some from receiving screens, Kauffman said.

7. Mixed information surrounding the age at which women should start
receiving mammograms is an issue, she said, partly because it varies across
expert groups.
The confusion has made an impact on the number of women who seek
services, Kauffman said.
The American Cancer Society revised its guidelines last year and
now recommends women begin mammograms at 45. It previously said
women should start them at 40. The National Comprehensive Cancer
Network suggests 40, while the U.S. Preventive Services Task Force
mammogram guidelines say 50.
The National Cancer Institute says studies haven't shown a benefit to
mammography in women younger than 40. The potential risks include false-
positives: when a mammogram appears abnormal but cancer isn't
present. They're more common for younger women, according to the
institute.
Additionally, mammograms can find cancers and tumors that won't cause
symptoms or threaten a woman's life. When those cases are treated, it
unnecessarily exposes women to side effects that come with cancer
therapy. On the other hand, young women also are more likely to have false-
negatives, which occurs when screens appear normal although cancer is
present, the institute says.
But Kauffman argued that recommendations rely on data and not individual
women.
"Those guidelines are not based on persons, they're based on populations,"
she said.
Age wasn't a factor when Heather Clough started to see changes in one of
her breasts while nursing her baby.

8. In 2015, she noticed it became larger, red and itchy. Clough, then 31, called
her nurse, who said her breast milk likely was drying up on that side.
After a couple of weeks, however, she still felt the inkling that something
wasn't right, so Clough called her nurse back and went in for a mammogram.
She had stage 4 inflammatory breast cancer.
Now cancer-free for two months, Clough advises women to always be
cautious of their bodies, even at a young age.
"It could be nothing, but you'd rather get it checked out and make sure it's
nothing than it be something and not get it taken care of," she said. "It could
happen to anybody, honestly."
Clough didn't have a family history of breast cancer, she added, which
Kauffman said also is a common misconception.
Fewer than 15 percent of women with breast cancer have had a family
member with the disease, according to the American Cancer Society.
"People use that as an excuse to prolong (receiving a mammogram),"
Kauffman said.
By dispelling these types of myths and raising year-round awareness about
the YWCA's program, she hopes more women will receive the services they
need to fight breast cancer.
"We're here," Kauffman said.
Contact J&C higher education reporter Meghan Holden at
mholden@jconline.com. Follow her on Twitter: @MeghanHolden.
Cancer resources
The YWCA of Greater Lafayette Women's Cancer Program serves 23

9. counties, including:
Benton, Boone, Carroll, Cass, Clay, Clinton, Fountain, Greene, Hamilton,
Howard, Jasper, Miami, Montgomery, Newton, Parke, Pulaski, Sullivan,
Tippecanoe, Tipton, Vermillion, Vigo, Warren and White.
The program offers access to several free services, including:
Mammograms, breast ultrasounds, biopsies, Pap tests, pelvic exams,
colposcopies and loop electrosurgical excision procedures, patient
navigation, transportation assistance, Spanish interpretation and new
and gently used prosthesis and bras.
Other community resources:
Community Cancer Network, Area IV Agency on Aging and Community
Action Programs Inc., Bauer Family Resources, and Lafayette Urban
Ministry.
By the numbers
The YWCA's Women's Cancer Program provided the following services for
free in 2015.
1,182 clinical breast exams.
1,301 breast exams.
251 breast ultrasounds.
731 Pap tests.
234 additional diagnostic procedures.