Community Profile 2004

As part of its mission, the Arkansas Affiliate of the Susan G. Komen Breast Cancer Foundation produces a bi-annual Community Profile providing appropriate demographics, breast cancer statistics,  and, at the same time, assessing breast health/breast cancer needs and services in the 65-county area served by the Affiliate.

EXECUTIVE SUMMARY

As part of its mission, the Arkansas Affiliate of the Susan G. Komen Breast Cancer Foundation produces a bi-annual Community Profile providing appropriate demographics, breast cancer statistics,  and, at the same time, assessing breast health/breast cancer needs and services in the 65-county area served by the Affiliate.

DEMOGRAPHICS

Arkansas has long been described as a small, rural state dependent upon an agrarian economy.  The sixty-five counties covered by this report aptly fit that description.  They range from the mountains of the west and north central regions to the low-lying farmlands of the east and southern Delta.  The region’s two million residents live primarily in rural areas, small communities or small cities.  The largest county, Pulaski, which is home to the capital city of Little Rock, has a population of approximately 360,000 residents.

Fifty-four percent of the area’s population are below age 40, while 15 percent are age 40-49; 17 percent, age 50-64; and 14 percent age 65 and above.  Men are a slight majority of the population under 40, but as age increases, the percentage of women increases, giving them a majority in each age grouping, with the largest disparity at age 65 and above.

The population breakdown for the 65-county area shows that 76.8 percent are Caucasian; 18.7 percent, African American; 2.4 percent, Hispanic; 0.6 percent, Asian; 0.5 percent

Native American; and 1.1 percent, all others.  For several years the largest-growing segment of the population has been Hispanic.  While the growth continues, the 2000 U.S. Census figures show that the Asian population is now growing at a faster rate.

The 1,072,527 women in the region comprise slightly more than half of the population.  Of these, more than half (551,907) are under age 40.  For those who have reached age 40, the baseline age recommended for annual mammography, the population breakdown shows 152,694 women age 40-49; 182,978, age 50-64; and 173, 690, age 65 and above.  In the 40-and-over age group, 424,218 (83 percent) are Caucasian; 75,535 (15 percent) are African American; 4,906 (one percent) are Hispanic; 2,654 (0.5 percent are Asian; and 2,049 (0.4 percent) are Native American.  (Figure 1)

In recent years, the small manufacturing and service sectors have moved alongside agriculture as important factors in the economy of the area.  Decreasing dependence upon labor-intensive agricultural practices in the Delta region and a decrease of 40,000 manufacturing jobs since 1995, have presented economic problems.  Despite the move toward diversification, the 2002 socio-economic indicators reflect that 26.8 percent of households in the region have an annual income of less than $20,000. ( Figure 2)

Figure 2

Percent of Households within the county that have an annual income of < 20K

             0 – 19.9 %           20 – 29.9%                30 – 39.9%                    40 – 49%

According to U.S. Census Bureau figures, 19 percent of Arkansans live below the poverty level, tying the state with Mississippi for the highest poverty rate in the nation.  In 2000, the federal poverty level was $14,348 for a family of three and $18, 392 for a family of four.  In actuality, according to the Census report, an income double the poverty level is a more accurate measure of what is required to pay for basic needs such as food, housing, clothing, transportation, child care and health care.  Poverty is highest in the Delta counties, but others are not immune.  Thirty-eight percent of jobs in Arkansas pay a median wage below the poverty level.  This low-income level is often combined with low educational level.  Forty-two percent of low-income working families in Arkansas include an adult with a high school diploma.  In terms of health care, it is currently estimated that 438,000 Arkansans are without health care coverage, a figure which makes up about 15 percent of the state’s population.

In terms of education, 15.3 percent of the population 25 years or older have less than a high school education; 18.3%, some high school; and 32.9%, a high school diploma.

(Figure 3)   According to the National Adult Literacy Survey twenty-two percent of the population within the state of Arkansas reads at or below the fifth grade level. Thirty-seven of the sixty-five counties within the affiliate area are worse than the state average.

Figure 3

Shaded counties:  > 40% of Adult Population has less than a HS Diploma

BREAST CANCER STATISTICS

From 1996-2000, the Arkansas incidence rate of female invasive breast cancer was 114.9 per 100,000, slightly lower than the U.S. rate of 131.7 (age adjusted to the 2000 U.S. standard population).  For 2004 the American Cancer Society estimates 2,050 Arkansas women will be diagnosed with breast cancer.

Incidence rates for the sixty-five counties within the Arkansas Affiliate were obtained from the Arkansas Central Cancer Registry of the Arkansas Department of Health.  These rates were for female in situ and invasive breast cancer (per 100,000, age adjusted to the 2000 U.S. standard population).  During 1996 – 2000 the rates ranged from 169.0 in Pulaski County to 76.7 in Calhoun County. (Figure 4)

Figure 4 

Breast Cancer Incidence Rates (AR Cancer Registry Data)

According to the CDC 1996-2000 statistics, the mortality rate from breast cancer among Arkansas women is 25.4 deaths per 100,000, again slightly below the national average of 27.7percent.  However, 31 of the counties in the 65-county service area exceed the overall state average. (Figure 5) The mortality rate for the state’s Caucasian women is 23.7 percent compared to 27.2 percent nationally.  While fewer African American women are diagnosed with breast cancer in Arkansas, their mortality rate is higher at 37.4 percent which is slightly higher than the national average for African American women of 35.9 percent.

Figure 5.

Shaded counties had mortality rates higher than State average in 1996-2000 (AR Cancer Registry Data)

An estimated 215,990 new cases of invasive breast cancer were expected to occur among women, and 1,450 among men, in the United States during 2004.  It is the most frequently diagnosed non-skin cancer in women.  These figures do not include the incidence of in situ breast cancer.  While the question emerges as to why breast cancer is the disease which most women acknowledge they fear the most, it is believed this fear is caused by the fact that there are few prevention methods.  The disease occurs with no warning signs except for a breast abnormality which all too often goes undetected without proper screening.  Also, it strikes at the core of women’s self-image, and treatment can sometimes be disfiguring.  The statistic that breast cancer strikes one out of every 7 American women in their lifetime is chilling.  Almost every individual and every family has either been directly affected by it or has a friend who has been.

Since early detection is the key to breast cancer survival and to more treatment options, regular screening becomes a vital component in fighting the disease.  Nationally, the percentage of women who report having had a mammogram within the past two years has been increasing.  While the rate has been higher for Caucasian women than for African American women, the gap is narrowing.  Between 1999 and 2002, there were only two years (1996, 2000) when the percentage of Caucasians having a mammogram during the past year was higher than that for African American women.  The percentage of Hispanic and Asian women screened for breast cancer, however, has remained low.  

It is estimated that mammographic detection of breast cancer improves survival by 25 percent.  In 1993, almost 30 percent of Arkansas women who were at or above the baseline age of 40 had never had a mammogram.  By 2002, the figure had dropped to 15 percent.  When narrowing this question to women who failed to get a mammogram within the past two years, the figure is also dropping.  In 1993, this figure stood at 44 percent; by 2002, it had dropped to 31.3 percent. (Figure 6)  The same holds true for women age 40 and above who have not had a clinical breast examination along with a mammogram.  These figures exceed the nationwide average.

Figure 6 (CDC BRFSS, 11.5.03)

In 2002 more than 80 percent of Arkansas women over 40 said they believed they should get a mammogram every year.   Yet it is reported that only 68.7 percent of them did so.  This is below the last nationally-reported figure of 76 percent in 2000.  A similar percentage, slightly less than 70 percent, had a clinical breast exam within the past year.

PROGRAM SERVICES OFFERED

Breast health education programs offered by health agencies, healthcare providers and community groups have increased in recent years, as have efforts to improve access to health care.  The effect of these programs is reflected in the improving mammography figures.  However, access to mammography in the 65 counties has been a problem.  Twenty-one of these counties have no on-site mammography facilities. (Figure 7)  

Figure 7

·         Mammography Sites     Number indicates more than one site per location

                                                   Shaded Counties lack permanent Mammography Sites

                                          Source:  FDA Center for Devices and Radiological Health

To address this problem, mobile mammography units from five Arkansas hospitals travel to distant sites, covering a combined total of 38 counties, in order to bring screening services to a wider population. (Figure 8)  However, four counties still have no on site or mobile coverage.  Access is improving, but the goal of complete county coverage remains.  The expense of maintaining mobile units, the availability of staff, the marketing of services, the rural nature of the state, and the cooperation of local communities combine to make mobile mammography a daunting task.

Figure 8

Lighter shaded counties have mobile mammography

Darker shaded counties have neither permanent or mobile mammography

A variety of resources exist for breast health services including hospitals, regional community health clinics, offices of the Arkansas Department of Health, and private medical practitioners.  With the cooperation of the Arkansas Hospital Association, a survey was undertaken of hospitals in the 65-county area.  Their responses provide a snapshot of services available, ranging from diagnostic tools to availability of treatment methods and services for breast cancer patients. (Figure 9)

 Full Service (Diagnostic, Surgical, Chemotherapy 
and/or Radiation, some MRI)

 Diagnostic and Surgical services without access to Chemotherapy, Radiation, MRI

 Minimal Diagnostic/Surgical services available

  Minimal Diagnostic Services available  

                    Figure 9

The most recent addition, the Breast Care Program in the Department of Health, was created by the passage in the Arkansas General Assembly of the Breast Cancer Act of 1997.  Under the legislation, persons falling 200 percent below the poverty level and ineligible for Medicaid benefits may receive free breast cancer screening and treatment.  The Centers for Disease Control funded the Breast and Cervical Cancer Control Program in 1995, providing screening services to low-income, under-insured women.  The number of women enrolling and re-enrolling in this program continues to grow.  The Arkansas Cancer Research Center at the University of Arkansas for Medical Sciences is the state’s only academically-based cancer research center.

KEY INFORMANT RESPONSES & SURVEYS OF HEALTH PROVIDERS

As part of this assessment, interviews were conducted with individuals in leadership positions in the Arkansas Affiliate service area to ascertain viewpoints about key health concerns, as well as beliefs and attitudes about breast cancer.  Those interviewed consistently ranked heart disease, cancer, diabetes, substance abuse and nutrition as the five most important health concerns in their communities.  While not asked to specify specific types of cancer, most cited breast cancer as a key concern.  When queried about breast cancer services, they listed the need for overcoming language barriers, lack of financial resources or insurance coverage, lack of information about breast health, and transportation for screening and treatment.

A major needs survey was undertaken among selected health-related agencies.  Ranking highest in their composite responses was the need for financial assistance for clients in obtaining mammograms.  A close second was the need for access to a mammography facility during non-working hours.  Ranked third was the need for availability of lymphedema treatment. 

An analysis of resources and support groups available was also conducted.  Recaps of interviews and surveys are included in this report.

GAPS AND PRIORITIES

From an analysis of the data gathered, the breast health and breast cancer needs and services in the Arkansas Affiliate service area have been identified.  Based on the findings, the needs have been ranked, and priorities established, in the following order:

            1.  Access to diagnosis and treatment

            2.  Education

            3.  Support and treatment for Survivors

            4.  Transportation needs and service

Efforts of the Affiliate to eradicate breast cancer as a life-threatening disease will be targeted, in priority order, toward these identified needs. 

RESOURCES

Demographic Analysis, Thomson Medstat, 2003

U.S. Census Bureau reports, September 2003

Cancer Information Service, National Cancer Institute

Arkansas Democrat-Gazette, September 28, 2003

Cancer Facts & Figures, 2003 & 2004, American Cancer Society

Cancer Prevention & Early Detection, Facts & Figures, 2003, American

Cancer Society

Centers for Disease Control, Statistics and Data

Arkansas Hospitals magazine, Summer 2003, Arkansas Hospital Association

The Arkansas Cancer Plan, 2001-2005

Behavioral Risk Factor Surveillance System (BRFSS), Centers for Disease Control

BRFSS Survey, Arkansas Center for Health Statistics, Arkansas Department of Health

Arkansas Breast Care, Arkansas Department of Health

Key Informant Survey, 2003, Arkansas Affiliate, Komen Foundation

Major Needs Survey, 2003, Arkansas Affiliate, Komen Foundation

Arkansas Hospital Association Survey, 2003

Community Demographic Profile

The Arkansas Affiliate is comprised of sixty-five of the seventy-five counties in the state of Arkansas.  Of the ten remaining counties, six are in the Ozark Affiliate and four are in the Texarkana Affiliate.

The sixty-five counties stretch from the northern border with Missouri, look across the Mississippi River on the east to Tennessee and Mississippi, border Louisiana on the south, and to the west, share the Ouachita Mountains with Oklahoma.  Within these counties, one can dig for diamonds in the only diamond mine in the United States, explore limestone caves in the Ozark Mountains in the north, float the country’s first National River, the Buffalo River,  soak in the thermal waters of our country’s first National Park, Hot Springs, hike trails through the 2.67 million acres of national  forest, fish the 600,000 acres of lakes and 9,700 miles of streams and rivers, and hunt ducks along the fly way of the Mississippi Delta.   While traveling through the affiliate service area, one can visit Nashville, Moscow, London, Paris, England, Palestine, and also stop by Pickle Gap or Toad Suck Lock and Dam.   Stopping in Little Rock, a visit can be made to the new William J. Clinton Presidential Center and Park with its museum, archival collection and educational and research facilities.  From the north western mountains, through the timberlands, prairies and central river valley, to the oxbow lakes and bayous of the south and eastern Delta, the sixty-five counties within the Arkansas Affiliate definitely demonstrate why Arkansas slogan is “The Natural State”.

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