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June 1, 2000
Breast Cancer: Cause and Controversy
Funding Crisis
There just isn't enough money devoted to the plight of African-American women in Bayview/Hunters Point.
Not enough for research, not enough for community outreach, not even enough for treatment.
In a world-famous city known for its six-figure dot-com incomes, there was no money around to keep a UCSF "mammovan" -- a mobile breast-health screening unit -- on the road. The van sat for years in a city parking lot, broken down.
Pullquote template can't be opened. "We finally paid someone to take it away," said Meridithe Mendelsohn, administrator for the breast care center at UCSF's Mt. Zion campus. "The van itself was broken and couldn't be fixed, and all the equipment was 10 years old and outdated anyway."
Record of shutdowns
The UCSF van used to roam through a six-county area, setting up on the streets of Hunters Point as well as in other pockets of underserved women, including some in Marin and other affluent counties.
But fundraising couldn't keep pace with the cost of equipment, staff and administrative backup.
"It's not just a van, you have to have a whole system in place," Mendelsohn said. "It's very important to be able to follow up with someone if you do find a positive result. Women need to have a place to get treated."
A new UCSF mammovan is in the works. Mendelsohn estimated it will cost about $1 million to get it on the road, including $500,000 for the van and equipment, plus another $500,000 for a year's operating budget.
Donors have been lined up to cover about half the total needed. There are also two state programs, a breast cancer early detection program and a fund for treatment subsidies, that UCSF hopes to tap into, along with other grant programs.
Meanwhile, two private mammography clinics in the city, Mission Imaging and Van Ness Imaging, both of which were relatively accessible to women in the underserved areas of most interest to Luce, are both long gone.
Shortage in San Francisco
It costs a lot of money to reach out to San Francisco's low-income communities, and the challenges are daunting.
Dianne Carr, director breast and cervical cancer services in the San Francisco Department of Public Health's Office of Women's Health, says the total budget for breast cancer outreach and care is "around $850,000 right now."
About half that money is federal, and disbursed through the state to city health department clinics, which serve San Francisco's poorest women. "That's for screening, and outreach, education, staff to support the programs," said Carr.
Clinic patients in need are referred to SF General, where the city's general fund has provided about $450,000 for two nurse practitioners (one who works out in the communities) and four "women's care navigators," said Carr, who offer advocacy, support and education.
"We only have four patient navigators, that's not enough," she noted. "We're rich compared to many other counties in California, and I think the mayor's office has been very responsive ... but you know you can always do more. We have one patient navigator who speaks Chinese [and one] that speaks Spanish, you know that they're both pretty busy."
Carr, resigned to financial realities, is bemused when asked what her "dream budget" might be.
"I haven't thought about that, not really," she said. "I'd like to have another $500,000 I guess. Why not?"
Ideally, Carr wants SF General to be a place "where a woman can walk in and get her mammogram, and if she needs an ultrasound, and then if she needs to go breast clinic," it would all be there, all integrated, "a little more user friendly. We're not working in isolation, we have to work with other departments that are also faced with budget constraints and budget changes."
More in Marin?
For Dr. Luce, the Bay Area cancer "cluster" has to do with economics, not suspicious substances.
Any toxic problems in Marin, she figures, must surely pale in comparison to what the women of Hunters Point must live with every day, and there's little clear evidence of a toxic cloud even at Hunters Point.
No one suggests the environmental research should not be done. "The question of whether there are significant factors in the environment that contribute to breast cancer problem is open," Luce said.
Still, why would there be more of that in Marin than anywhere else?
"Disparities in cancer rates are there, but so are differences in ethnic breakdowns and community income," Luce said. "Higher income, better educated women have fewer children. So there's less exposure to sex hormones. Maybe that's enough to explain it."
Next: A Tale of Two Counties
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Breast Cancer: CAUSE & CONTROVERSY by Carl Hall photographs by Pico  SIDEBARS: Photo Gallery: Breast cancer survivors carry on. (Pico) Long Island: A mammoth research effort and its critics. (Hall) Risk factors offer questions and answers. (Wilson)
Toxic Links: How do we know if a chemical is dangerous? (Wilson)
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