Every morning, Fulvia Sotillo commutes from her apartment in the Soundview section of the Bronx to the Goldman Sachs office in downtown Manhattan, where she works part-time as a cashier in the kitchen.
She is 62 years old, an age that should mean she gets breast cancer screening every year. But she has not had a mammogram for so long that she cannot even remember her last one.
“The cost is too high,” said Sotillo, whose daughter, Giselle Ellis, translated from Spanish to English for her. “I can’t afford it.”
Even though suffers from diabetes and high blood pressure, Sotillo does not have health insurance coverage. Because she is only 62, she is not eligible for Medicare, which begins at age 65. Her income from a part-time job is too much to qualify for Medicaid and too little to enroll in a private insurance plan or get a mammogram.
There are approximately 20,000 uninsured women over the age of 40 like Sotillo in the Bronx, according to Kathleen O’Hanlon, director of the New York State Department of Health Cancer Services Program of Bronx County, which provides free mammograms to uninsured women over the age of 40. But last year, only about 3, 000 of them got screened for breast cancer through the program.
According to Susan G. Komen For the Cure foundation, low-income women have lower screening rates. They are 41 percent more likely to be diagnosed with late-stage breast cancer and are three times more likely to die from breast cancer. Women without insurance are more likely to receive a late-stage breast cancer diagnosis and are 30 to 50 percent more likely to die from the disease than women with insurance.
“Mammogram is a very effective screening tool, especially for women over the age of 50,” said Mary Beth Terry, an associate professor of epidemiology at Columbia University’s Mailman School of Public Health. She said by detecting small tumors that are not easily discovered, mammograms can lower the death rate from breast cancer.
And yet, most low-income and uninsured women go unscreened for years for many reasons.
“Awareness is a big one,” said Emma Pena, the mobile mammography van program case manager for St. Barnabas Hospital in the East Tremont section of the Bronx. Pena said many women do not know the dangers of late-stage tumors and the importance of early detection.
The mobile van tries to change that by reaching women where they work and live. Funded through the Cancer Services Program, it goes to different community health centers, schools, senior centers and health fairs in the Bronx three days a week. It also sends out fliers both in English and Spanish.
On a recent morning, Alberta Catalano lit up a cigarette in front of the Bronx Family Court building. She had accompanied a friend to court, and although pink ribbons were everywhere because October was breast cancer awareness month, the first pink ribbon she had ever seen was the one painted on the mobile mammography van that pulled up in front of the court.
“I really don’t like mammograms,” said Catalano, 59. She had her last mammogram five years ago, and it hurt so much that she decided not to have another, although the current recommendation by most major medical groups is that women over 50 get screened for breast cancer every year.
Even though the huge white van was right beside the sidewalk where Catalano was enjoying her second cigarette, and the doctors in the van could get her screened for free in less than 30 minutes, she could not stop talking about her previous bartending job, and how bored she has been in her Throgs Neck apartment since she lost that job five years ago.
The van spent four hours in front of the court building that morning, and did not receive any uninsured women, who are the major targets of the program. Most of the women who used it were court employees who made appointments in order to get screened during lunch break rather than losing a day’s work.
Maureen McCarthy, the mobile van program coordinator, said she wishes the program could expand, especially among uninsured women.
“This is a population you don’t want to lose,” said McCarthy, 70. “Because this is a disease that with early intervention it can have a good cure rate.”
McCarthy poked her head out of the door, inviting the women passing by to come into the van. Most of them paid no attention as if avoiding restaurant fliers. Some of them did come up to the van, but they all had medical insurance.
Last year, the mobile van saw approximately 1,000 women, only a third of them were uninsured.
Pena said some women do not take mammograms regularly because they are preoccupied by taking care of their families or even battling other diseases.
That’s the case with Pamela Ramzie, 63, who suffers from neck and shoulder strains, sleep disorder and vertigo. She cannot work. She lives with a friend on Harrison Avenue in the Morris Heights section of the Bronx.
“A lot of the time I can’t even get out of bed,” said Ramzie, as she waited for her bag of free food at Part of the Solution, a community center that helps the poor.
Ramzie had her last mammogram three years ago, when she still had Supplemental Security Income. She lost it a year ago after going back to her home country, Jamaica, for five months. Federal law states that in order to qualify for Supplemental Security Income, the recipient cannot leave the U.S. for 30 days or more in a row.
“Life is very hard,” said Ramzie, who is still uninsured. “Sometimes mammogram is just not first on my list.”
Another barrier for uninsured women is immigration documentation. Pena said many uninsured women are illegal immigrants who are afraid to seek any kind of health care.
“But we don’t ask for any immigration papers on the van,” said McCarthy. The program requires only the woman’s name, age, and related medical history. Uninsured women would then sign another form that records them as eligible for the free test.
Depending on the kind of follow-up examinations needed, the cost of screening one woman ranges from $200 to $3,000. According to O’Hanlon, the Cancer Services Program has more funding than the amount that is being used now. “We need more women to come for screening,” said O’Hanlon, who urges low-income and uninsured women to make use of the free mammogram service.