Breast cancer is the most common type of cancer among women with 1 in 8 women being diagnosed in their lifetime. Not knowing the specific cause of breast cancer mandates a thorough examination of those affected; behavioral trends and available programs and services. The following report presents the latest demographic, statistical and anecdotal information within El Paso County. Specifically, the report will provide general demographics of El Paso County, demographics of women in El Paso County, breast cancer statistics, summary of programs and services and key informant information. Ultimately, the gathered information provides critical insight into the gaps within El Paso County and identifies the breast health needs of women and men throughout our service area.

El Paso County resides in far West Texas on the border of New Mexico and Juarez, Mexico. The county consists of approximately 713,126 individuals. The ethnic breakdown of El Paso County is represented by 78.2% Hispanic/Latinos; 17% Caucasians and 3.5% African Americans. El Paso County is primarily a young community with 35.3% of El Pasoans under the age of 19. The remaining age breakdown is as follows:

Within El Paso County, the average household income is $29,988. Upon further review of household by income, the socioeconomic status of El Pasoans is reflected by the following:

Poverty is measured as a yearly income of under $17,463 for family of four with 2 children. In 2003, 27.4% of families were living below poverty.

In terms of education, 31.4% of El Pasoans have less than a high school degree; 22.5% have a high school degree; 27.8% have some college or an associate degree; 12.1% have a bachelors degree or higher and 6.1% have a graduate degree or higher.

In summary, El Pasoans are primarily young, Hispanic/Latinos lacking higher education and on average, having household incomes below $30,000.

Within El Paso County, there are approximately 261,262 women. Of these women, 81.8% are Hispanic/Latina; 15% are Caucasian and 1.6% are African American. Upon comparison, within Texas, 54% are Caucasian and 30.4% are Hispanic/Latina. In terms of age, El Paso women are predominately young with the leading number of women being less than 40 years of age; followed by women ages 40-49, 50-59, 65+ and 60-64 years of age. By comparison, Texans are overall very young; however, Caucasians rather than Hispanics are the largest group within each age group. In reviewing the age category <40 within Texas, it is extremely interesting the slight difference among Caucasians (1,596,383) and Hispanics/Latinas (1,366,059). These numbers are congruent with the rapid growth of Hispanics/Latinos within Texas and throughout the United States.

In terms of education, El Paso women are most likely to have less than a high school degree and less likely to have some post high-school or high school degree/GED and least likely to be a college graduate. Conversely in Texas, women are most likely to have some post high school and less likely to have a high school degree or GED or college graduate and least likely to have less than a high school degree. In addition to education levels, the latest statistics from the U.S. Census Bureau report that 78.2% of El Pasoans speak another language beside English in their home.

Within El Paso, the number of households with $50,000+/per year are the greatest followed by less than $15,000, $35,000-$49,999; $15,000-$24,999 and $25,000-$34,999. In comparison to State income levels, the greatest number of households are those making $50,000+ per year followed by $35,000-$49,999; < $15,000; $25,000-$34,999 and $15,000-24,999.

In summary, El Paso women, like the general population of El Paso, are primarily young, Hispanic/Latinas lacking higher education and the majority of women reside in households (67%) with income less than $50,000.

In El Paso, it is estimated that 615 women will be diagnosed with breast cancer this year. Of those that will be diagnosed, 365 will be Caucasian; 176 Hispanic/Latina; 67 Other and 7 African American. In comparison, 16,027 women will be diagnosed with breast cancer in Texas. Of those, 11,161 will be Caucasian; 2,065 Hispanic/Latina; 1,552 Other and 1249 African American. In addition, 144 women will be diagnosed with in situ breast cancer in El Paso as compared to 3,823 within Texas.

In terms of mortality, 121 women will die from breast cancer this year in El Paso and 3,165 women within Texas. Of those in El Paso, 66 will be Caucasian; 45 Hispanic/Latina; 8 Other and 2 African American. In Texas, 2,027 Caucasian women will die from breast cancer followed by 526 Hispanic/Latina women, 422 African American women and 190 Other women. These statistics are somewhat consistent with National trends; however, in a predominately Hispanic/Latina community, one might expect a greater number of cases among Hispanics/Latinas.

The latest screening data reports that within Texas, 5,219,264 women were screened for breast cancer. In El Paso, 164,487 women were screened for breast cancer. In comparing the number of women screened to the total number of women, approximately 62.9% of women are being screened for breast cancer.

Upon further breakdown in El Paso, the following age groups most commonly receiving breast cancer screening in descending order: 40-49; 65+; 50-59; <40 and 60-64 years old. This is synonymous with statewide screening trends according to age. In terms of education, those with less than a high school degree are the most likely to get screened followed by some post high school, high school degree/GED and college graduate. Interestingly enough, of those that reported that they have not been screened, the majority had less than a high school degree. These numbers translate into the need to focus education and screening efforts on women ages 60-64 (pre-Medicare) and to women of all education levels with a possible focus on women in the workplace.

Conversely, in terms of household income, women in households with an income of $50,000+, are the most likely to receive screening. This information does not match in terms of education since those with less than a high school degree are most likely to get screened. Women living in households with an annual income of less than $15,000 are next likely to be screened followed by $35,000-$49,999; $15,000-$24,999 and $25,000-$34,999.

In terms of frequency, El Paso women are most likely to get a mammogram every three years followed by a mammogram every year, every 2 years, every 5+ years and every 5 years. Of those women, who receive a mammogram every 3 years, they are Caucasian, aged 40-49 years, less than a high school degree and living in households with an income of $50,000 per year.

In summary, 615 women will be diagnosed and 121 women will die of breast cancer within El Paso County this year. The majority of women diagnosed and die are Caucasian; followed by Hispanic/Latina women. Incidence data is consistent with national trends; however, mortality data differs from national trends. In terms of breast cancer screening, 62.9% of women report receiving a mammogram. Of those, the most likely to receive a mammogram are women age 40-49 with less than a high school degree and women with a household income greater than $50,000 per year. Those least likely to receive are women age 60-64 years old, college graduates and with household incomes of $25,000-$34,999. Women are most likely to receive a mammogram once every three years.

El Paso County has a wealth of breast health/breast cancer services for men and women. In total, 30 different clinics, hospitals, private businesses and non-profit organizations submitted surveys—of those that submitted—their services range from the provision of education, screening, treatment, post-treatment, transportation and support services.

The majority of the services are provided in the zip code 79901 and 79902. In addition, services exist further West and East of these zip codes in highly concentrated zip codes. Lacking areas include the lower valley of El Paso, primarily 79907 and 79915 as well as the outlying regions or rather the “Colonias” of El Paso.

The majority of facilities accept private insurance, self-pay, Medicare and Medicaid. Very few of the facilities accommodate those lacking financial resources.

In summary, services and programs are needed to accommodate individuals in the Southern part of El Paso, the Colonias and the Lower Valley. Additional funds are needed to subsidize screening and treatment to individuals and clinics residing in these areas.

Key informants are leaders in the community and are extremely knowledgeable of the breast health/breast cancer “gaps” and the necessary services to decrease breast cancer mortality throughout El Paso.

Key informants believe that El Paso is plagued by chronic illness and rank diabetes, heart disease and cancer at the top of their health concern list. Following the list of diseases, key informants rank nutrition, violence and stress as contributing factors of the diseases. The key informants view traditional methods such as doctors, clinic staff, nurses/allied health professionals and pharmacists as those best to provide health information.

In addition to traditional methods, key informants also believe friends and “promotoras” to play an important role in promoting breast health messaging. As expected, the media plays a big role in distributing breast health information. Key informants believe that efforts should be focused on television, public presentations, radio, brochures/pamphlets, videos, newspaper and church bulletins. Traditional Spanish-language media is a recommended outlet for breast health messaging.

According to key informants and as inferred by the socioeconomic status of El Paso County, the majority of women seeking healthcare, utilize Medicare/Medicaid or charity funding because they cannot afford the service. Most of the low-income and underserved women seeking breast healthcare or screening will utilize community or public clinics. Hispanics, Caucasians and Women with low literacy are those that are seeking breast cancer screening that did not do so 2 years ago. Motivators for this behavior include the recommendation of a physician; own decision or that they felt a lump or an abnormality.

Key informants grouped those in greatest need of services as the following:

Greatest need: Hispanic/Latinas, Low income, 40-49, 50-64

Great need: Low Literacy, Men, Migrant Workers, Refugees/Immigrants, Uninsured/Underinsured

Need: African Americans, Caucasians, Hearing impaired, Homeless women, Incarcerated, Lesbians, Mentally challenged, Native Americans, Disabled, Rural, 65+ and <40 years of age

Several factors prohibit women from seeking breast cancer screening. According to the key informants, these are the most prevalent reasons:

1. Costs: Poverty, Uninsured/Underinsured, Cannot Afford Services, Cannot take time off from work, Cannot afford transportation
2. Access: Too far, Rural area, Lack of medical providers
3. Fears: Accessing the system; Losing a breast; Having cancer; Results of a test; Procedures/Pain; Going to the Doctor
4. Education/Awareness: Myths; Not Aware of Risk; Do not have information about preventive care; Not aware of programs in the community; Not discussed or recommended by a physician
5. Cultural/Behavioral: Procrastination; Other health problems are more important; Embarrassment/Modesty; Fatalism

Key informants view the healthcare system as doing an inadequate job in regards to providing information in regards to risk factors, prevention, early detection, screening and research. Healthcare systems are doing an adequate job at diagnosing breast cancer, providing treatment and after-treatment care and support. None of the key informants believe that the healthcare system is moderately successful or successful in providing breast health and breast cancer services to the community.

Several solutions were recommended by the key informants; however, upon review, their solutions could be summarized as the following:

1. Increase breast health education/outreach efforts
2. Increase the number of mammograms provided throughout the county
3. Increase financial support to breast cancer patients undergoing treatment and post-treatment services

In summary, breast cancer is a leading concern of key informants. An increase in breast cancer awareness can be achieved through traditional methods as well as the utilization of promotoras, friends and Spanish media. Women lack the financial resources to obtain screening; however, when screened, prefer a public or community clinic. Those in greatest need of breast cancer services include Hispanics/Latinas, low-income women, women ages 40-49 and 50-64. To increase screening rates, focus should be given to lessening cost, increasing access, alleviating fears, increasing breast cancer knowledge and understanding the culture.

In conclusion, the gathered information has assisted in the identification of breast health gaps in services throughout El Paso County. The identified gaps will serve as focus areas for our Mission programs and funding at the Affiliate level. The gaps and goals are as follows:

1. Lack of affordable screening
   
   62.9% of women are being screened in El Paso County. In addition, approximately 112,510 women should be receiving annual mammograms based on their age. The El Paso Affiliate is currently funding 1250 mammograms per year.
    
2. Lack of financial resources for treatment (including surgeries, adjuvant therapies and medications)
   
   With approximately 615 women being diagnosed each year, additional resources are necessary for the breast cancer patients lacking the financial means to undergo treatment and follow-up.
    
3. Lack of accessibility to breast health services
   
   Access continues to be a problem for women residing with South El Paso, the Lower Valley and the Colonias. Increase funding for transportation or bring the necessary services to those in need.
    
4. Lack of breast health education to women, primarily women in the workplace, women ages 50-64, women in the Colonias and young women
   
   Data shows that women least likely to receive a mammogram are college-educated, women that possibly might be lacking insurance and do not qualify for Medicare (ages 50-64) and women in the outlying areas of the Colonias who cannot afford a mammogram or who cannot access the services. In addition, focus should be given to young women due to El Paso’s young population.
    
5. Lack of focused Spanish breast health messaging via traditional media outlets
   
   Data shows that women respond to Spanish television, radio and newspapers. In addition, focus on reaching out to women via church bulletins, educational materials and breast health presentations.

The goals for the El Paso Affiliate over the next two years are as follows:

1. Increase awareness of early detection and funding of breast cancer screening throughout El Paso County
2. Increase the provision of financial resources for treatment and post-treatment services
3. Increase accessibility to breast health services in outlying areas of El Paso including but not limited to the Lower Valley and Colonias
4. Increase breast health educational efforts to women in the workplace, women ages 50-64, young women including those in high school and middle school
5. Develop partnerships with promotora programs to increase awareness to women in the Colonias about breast cancer
6. Develop partnerships with Ft. Bliss to educate the influx of families estimated to arrive in El Paso County during the next couple of years
7. Continue efforts to provide breast cancer survivors with resources about treatment, post-treatment and support services

In conclusion, the Affiliate will focus their efforts on the key obstacles as identified by key informants—Cost, Access, Fears, Education and Cultural/Behavioral factors. By acknowledging the gaps and working towards our goals, the El Paso Affiliate hopes to increase screening and survivorship and decrease mortality throughout El Paso County. Our efforts will focus on the provision of screening and treatment services and increased educational outreach to women of all ages, ethnicities, levels of education and socioeconomic status. We look forward to working towards our Mission of eradicating breast cancer within our service area of El Paso County.